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CLINICAL STUDIES

Cardiac troponin I levels and clinical outcomes in patients with acute coronary syndromes

The potential role of early percutaneous revascularization

^a Cardiac Catheterization Laboratory, Washington Hospital Center, Washington, DC, USA
^b The Cardiovascular Research Foundation, Washington Hospital Center, Washington, DC, USA

Manuscript received March 4, 1999; revised manuscript received June 18, 1999, accepted August 18, 1999.

Reprint requests and correspondence: Dr. Ran Kornowski, Cardiology Research Foundation, Washington Hospital Center, 110 Irving St. NW, Suite 4B-1, Washington, DC 20010.
rxk3{at}mhg.edu

OBJECTIVES

To establish the role of early catheter-based coronary intervention among patients sustaining acute coronary syndromes (ACS) stratified according to admission plasma troponin I (Tn-I) levels.

BACKGROUND

The impact of early revascularization strategy on the clinical outcomes in patients with ACS stratified by plasma Tn-I levels has not been established.

METHODS

In-hospital complications and long-term outcomes were assessed in 1,321 consecutive patients with non-ST elevation ACS undergoing early (within 72 h) catheter-based coronary interventions. Patients were grouped according to admission Tn-I levels. Group I (n = 1,099) had no elevated plasma Tn-I (<0.15 ng/ml), Group II (n = 95) had Tn-I level between 0.15 to 0.45 ng/ml and Group III (n = 127) had Tn-I > 0.45 ng/ml. In-hospital composite cardiac events (death, Q-wave MI, urgent in-hospital revascularization) and 8 months clinical outcomes (death, MI, repeat revascularization or any cardiac event) were compared between the three groups.

RESULTS

The rate of in-hospital composite cardiac events was 6.1% among patients with Tn-I > 0.45 ng/ml, 1.0% in patients with Tn-I between 0.15–0.45 ng/ml and 3.1% in patients without elevated admission Tn-I (p = 0.09 between groups). There was no difference in hospital mortality (p = 0.25). At eight months of follow-up, there was no difference in out-of-hospital death (3.5%, 3.8% and 1.8%, p = 0.17, respectively), MI (2.6%, 3.8% and 2.9%, p = 0.94) or target lesion revascularization (9.0%, 8.3% and 11.5%, p = 0.47), and cardiac event-free survival was also similar between groups (p = 0.66). By multivariate analysis, Tn-I > 0.45 ng/ml was independently associated with in-hospital composite cardiac events [odds ratio (OR) = 2.4, p = 0.04] but not with out-of-hospital clinical events up to eight months.

CONCLUSIONS

In patients with ACS, early (within 72 h) catheter-based coronary intervention may attenuate the adverse prognostic impact of admission Tn-I elevation during eight months of follow-up despite a trend towards increased in-hospital composite cardiac events.

Abbreviations and Acronyms   ACS = acute coronary syndromes   CI = confidence interval   CK-MB = creatine kinase MB fraction   ECG = electrocardiogram   MI = myocardial infarction   OR = odds ratio   TLR = target lesion revascularization   Tn-I = troponin I   Tn-T = troponin T

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