Advertisement

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME

About the Journal
Editorial Board & Staff

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

ACC.org
Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions

Click here for more guidelines.
ACCF/ASNC/ACR/
AHA/ASE/SCCT/
SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging
SCIENCE ADVISORY: Percutaneous Device Closure of Patent Foramen Ovale for Secondary Stroke Prevention
ACCF/AHA 2009 Expert Consensus Document on Pulmonary Hypertension
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2000; 36:1812-1817
© 2000 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Morrow, D. A.
Right arrow Articles by Braunwald, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Morrow, D. A.
Right arrow Articles by Braunwald, E.

CLINICAL STUDY: ACUTE CORONARY SYNDROMES

Cardiac troponin I for stratification of early outcomes and the efficacy of enoxaparin in unstable angina: a TIMI-11B substudy

David A. Morrow, MDa, Elliott M. Antman, MD, FACCa, Milenko Tanasijevic, MDb, Nader Rifai, PhDc, James A. de Lemos, MDa, Carolyn H. McCabe, BSa, Christopher P. Cannon, MD, FACCa and Eugene Braunwald, MD, FACCa

a Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
b Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
c Department of Laboratory Medicine, Children’s Hospital, Boston, Massachusetts, USA

Manuscript received December 30, 1999; revised manuscript received May 8, 2000, accepted June 28, 2000.

Reprint requests and correspondence: Dr. David A. Morrow, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115
damorrow{at}bics.bwh.harvard.edu

Objectives

We sought to evaluate cardiac troponin I (cTnI) for predicting early clinical outcomes and the efficacy of enoxaparin among patients with non–ST segment elevation acute coronary syndrome (ACS) and negative creatine kinase, MB fraction (CK-MB) levels.

Background

Cardiac TnI identifies patients with unstable angina who are at higher risk of death or myocardial infarction (MI) by 30 days. The utility of cTnI for predicting very early clinical events, including recurrent ischemia, and the efficacy of enoxaparin are not yet established.

Methods

At baseline and 12 h to 24 h after enrollment in the Thrombolysis in Myocardial Infarction (TIMI)-11B trial, samples were collected for cTnI determination.

Results

Among 359 patients with negative serial CK-MB values, 50.1% had a cTnI result ≥0.1 ng/ml within the first 24 h. Patients with elevated cTnI were at higher risk of death or MI at 48 h (3.9 vs. 0%, p = 0.01) and 14 days (13.9 vs. 2.2%, p < 0.0001). Elevated cTnI also correlated with higher risk of recurrent ischemia requiring urgent revascularization by 48 h (10.0 vs. 1.7%, p = 0.001) and 14 days (20.6 vs. 5.6%, p ≤ 0.0001). Enoxaparin had a greater benefit among patients with elevated vs. normal cTnI (p = 0.03), achieving a 47% reduction in the risk of death, MI or urgent revascularization by 14 days in cTnI-positive patients (p = 0.007).

Conclusions

Elevation of cTnI among patients with non–ST segment elevation ACS and negative levels of CK-MB identifies those at higher risk for very early adverse outcomes, including severe recurrent ischemia. Treatment with enoxaparin reduces the risk associated with elevated cTnI.

Abbreviations and Acronyms
  ACS = acute coronary syndrome
  CABG = coronary artery bypass graft surgery
  CI = confidence interval
  CK-MB = creatine kinase, MB fraction
  cTnI = cardiac troponin I
  MI = myocardial infarction
  PTCA = percutaneous transluminal coronary angioplasty
  TIMI = Thrombolysis in Myocardial Infarction
  UFH = unfractionated heparin
  ULN = upper limit of normal




This article has been cited by other articles:


Home page
 Circ Cardiovasc GenetHome page
A. Rohatgi and J. A. de Lemos
The Report Card on Growth Differentiation Factor 15: Consistent Marks But Not Yet Ready for Promotion
Circ Cardiovasc Genet, June 1, 2009; 2(3): 209 - 211.
[Full Text] [PDF]

Home page
 Circ Cardiovasc Qual OutcomesHome page
S. A. Halim, J. Mulgund, A. Y. Chen, M. T. Roe, E. D. Peterson, W. B. Gibler, E. M. Ohman, and L. K. Newby
Use of Guidelines-Recommended Management and Outcomes Among Women and Men With Low-Level Troponin Elevation: Insights From CRUSADE
Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 199 - 206.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
J. S Alpert, K. Thygesen, A. Jaffe, and H. D White
The universal definition of myocardial infarction: a consensus document
Heart, October 1, 2008; 94(10): 1335 - 1341.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
M. P. Bonaca and D. A. Morrow
Defining a Role for Novel Biomarkers in Acute Coronary Syndromes
Clin. Chem., September 1, 2008; 54(9): 1424 - 1431.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
C D Miller, G J Fermann, C J Lindsell, K W Mahaffey, W F Peacock, C V Pollack, J E Hollander, D B Diercks, W B Gibler, and J W Hoekstra on behalf of the EMCREG-International
Initial risk stratification and presenting characteristics of patients with evolving myocardial infarctions
Emerg. Med. J., August 1, 2008; 25(8): 492 - 497.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, and R. H. Christenson
National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes
Circulation, April 3, 2007; 115(13): e356 - e375.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
NACB WRITING GROUP MEMBERS, D. A. Morrow, C. P. Cannon, R. L. Jesse, L. K. Newby, J. Ravkilde, A. B. Storrow, A. H.B. Wu, R. H. Christenson, NACB COMMITTEE MEMBERS, et al.
National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes
Clin. Chem., April 1, 2007; 53(4): 552 - 574.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. S. Jaffe, L. Babuin, and F. S. Apple
Biomarkers in Acute Cardiac Disease: The Present and the Future
J. Am. Coll. Cardiol., July 4, 2006; 48(1): 1 - 11.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. K. Newby, M. T. Roe, A. Y. Chen, E. M. Ohman, R. H. Christenson, C. V. Pollack Jr, J. W. Hoekstra, W. F. Peacock, R. A. Harrington, R. L. Jesse, et al.
Frequency and Clinical Implications of Discordant Creatine Kinase-MB and Troponin Measurements in Acute Coronary Syndromes
J. Am. Coll. Cardiol., January 17, 2006; 47(2): 312 - 318.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
Part 5: Acute Coronary Syndromes
Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72.
[Full Text] [PDF]

Home page
 CMAJHome page
L. Babuin and A. S. Jaffe
Troponin: the biomarker of choice for the detection of cardiac injury
Can. Med. Assoc. J., November 8, 2005; 173(10): 1191 - 1202.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. S. Ginsburg, M. P. Donahue, and L. K. Newby
Prospects for Personalized Cardiovascular Medicine: The Impact of Genomics
J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1615 - 1627.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
M. T. Roe, E. D. Peterson, Y. Li, C. V. Pollack Jr, R. H. Christenson, W. F. Peacock, F. M. Fesmire, L. K. Newby, R. L. Jesse, J. W. Hoekstra, et al.
Relationship Between Risk Stratification by Cardiac Troponin Level and Adherence to Guidelines for Non-ST-Segment Elevation Acute Coronary Syndromes
Arch Intern Med, September 12, 2005; 165(16): 1870 - 1876.
[Abstract] [Full Text] [PDF]

Home page
 Postgrad. Med. J.Home page
C-K Wong and H D White
Implications of the new definition of myocardial infarction
Postgrad. Med. J., September 1, 2005; 81(959): 552 - 555.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
M. A. Blazing, J. A. de Lemos, H. D. White, K. A. A. Fox, F. W. A. Verheugt, D. Ardissino, P. M. DiBattiste, J. Palmisano, D. W. Bilheimer, S. M. Snapinn, et al.
Safety and Efficacy of Enoxaparin vs Unfractionated Heparin in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes Who Receive Tirofiban and Aspirin: A Randomized Controlled Trial
JAMA, July 7, 2004; 292(1): 55 - 64.
[Abstract] [Full Text] [PDF]

Home page
 JAOA: Journal of the American Osteopathic AssociationHome page
G. E. Ross, F. N. Bever, Z. Uddin, L. Devireddy, and J. M. Gardin
Common Scenarios to Clarify the Interpretation of Cardiac Markers
J Am Osteopath Assoc, April 1, 2004; 104(4): 165 - 176.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. C. Kontos, R. Shah, L. M. Fritz, F. P. Anderson, J. L. Tatum, J. P. Ornato, and R. L. Jesse
Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients
J. Am. Coll. Cardiol., March 17, 2004; 43(6): 958 - 965.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
S. D. Wiviott, C. P. Cannon, D. A. Morrow, S. A. Murphy, C. M. Gibson, C. H. McCabe, M. S. Sabatine, N. Rifai, R. P. Giugliano, P. M. DiBattiste, et al.
Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A TACTICS-TIMI 18 (Treat Angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18) Substudy
Circulation, February 10, 2004; 109(5): 580 - 586.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
H. D. White and J. K. French
Use of brain natriuretic peptide levels for risk assessment in non-ST-elevation acute coronary syndromes
J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1917 - 1920.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
A. S. Jaffe
A small step for man, a leap forward for postoperative management
J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1555 - 1557.
[Full Text] [PDF]

Home page
 CirculationHome page
J. Lund, Q.-P. Qin, T. Ilva, K. Pettersson, L.-M. Voipio-Pulkki, P. Porela, and K. Pulkki
Circulating Pregnancy-Associated Plasma Protein A Predicts Outcome in Patients With Acute Coronary Syndrome but No Troponin I Elevation
Circulation, October 21, 2003; 108(16): 1924 - 1926.
[Abstract] [Full Text] [PDF]

Home page
 British Journal of Diabetes & Vascular DiseaseHome page
I. L Williams, B. Noronha, and A. G Zaman
Review: The management of acute myocardial infarction in patients with diabetes mellitus
The British Journal of Diabetes & Vascular Disease, September 1, 2003; 3(5): 319 - 324.
[Abstract] [PDF]

Home page
 CirculationHome page
C. P. Cannon and A. G.G. Turpie
Unstable Angina and Non-ST-Elevation Myocardial Infarction: Initial Antithrombotic Therapy and Early Invasive Strategy
Circulation, June 3, 2003; 107(21): 2640 - 2645.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. K. Newby, B. U. Goldmann, and E. M. Ohman
Troponin: an important prognostic marker and risk-stratification tool in non-ST-segment elevation acute coronary syndromes
J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 31S - 36S.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
G. J. Blake and P. M. Ridker
C-reactive protein and other inflammatory risk markers in acute coronary syndromes
J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 37S - 42S.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
E. J. Topol
A guide to therapeutic decision-making in patients with non-ST-segment elevation acute coronary syndromes
J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 123S - 129S.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo
Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation
Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840.
[Full Text] [PDF]

Home page
 CirculationHome page
C. P. Cannon
Evidence-Based Risk Stratification to Target Therapies in Acute Coronary Syndromes
Circulation, September 24, 2002; 106(13): 1588 - 1591.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J. A. de Lemos, D. A. Morrow, C. M. Gibson, S. A. Murphy, M. S. Sabatine, N. Rifai, C. H. McCabe, E. M. Antman, C. P. Cannon, and E. Braunwald
The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes: Results from the TIMI 11B and TACTICS-TIMI 18 studies
J. Am. Coll. Cardiol., July 17, 2002; 40(2): 238 - 244.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
C. Hamm
Acute coronary syndrome: the struggle for the best in risk stratification and therapy
Eur. Heart J., July 2, 2002; 23(14): 1074 - 1076.
[Full Text] [PDF]

Home page
 NEJMHome page
E. M. Antman
Decision Making with Cardiac Troponin Tests
N. Engl. J. Med., June 27, 2002; 346(26): 2079 - 2082.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
E.M. Antman, M. Cohen, C. McCabe, S.G. Goodman, S.A. Murphy, and E. Braunwald
Enoxaparin is superior to unfractionated heparin for preventing clinical events at 1-year follow-up of TIMI 11B and ESSENCE
Eur. Heart J., February 2, 2002; 23(4): 308 - 314.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
D.A. Morrow, E.M. Antman, S.M. Snapinn, C.H. McCabe, P. Theroux, and E. Braunwald
An integrated clinical approach to predicting the benefit of tirofiban in non-ST elevation acute coronary syndromes. Application of the TIMI Risk Score for UA/NSTEMI in PRISM-PLUS
Eur. Heart J., February 1, 2002; 23(3): 223 - 229.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
D. A. Morrow, C. P. Cannon, N. Rifai, M. J. Frey, R. Vicari, N. Lakkis, D. H. Robertson, D. A. Hille, P. T. DeLucca, P. M. DiBattiste, et al.
Ability of Minor Elevations of Troponins I and T to Predict Benefit From an Early Invasive Strategy in Patients With Unstable Angina and Non-ST Elevation Myocardial Infarction: Results From a Randomized Trial
JAMA, November 21, 2001; 286(19): 2405 - 2412.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
J. A. de Lemos, D. A. Morrow, J. H. Bentley, T. Omland, M. S. Sabatine, C. H. McCabe, C. Hall, C. P. Cannon, and E. Braunwald
The Prognostic Value of B-Type Natriuretic Peptide in Patients with Acute Coronary Syndromes
N. Engl. J. Med., October 4, 2001; 345(14): 1014 - 1021.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
E.M. Antman, R. Corbalan, K. Huber, and A.S. Jaffe
Issues in early risk stratification for UA/NSTEMI
Eur. Heart J. Suppl., August 1, 2001; 3(suppl_J): J6 - J14.
[Abstract] [PDF]

Home page
 Eur Heart J SupplHome page
J.S. Alpert, A.J. Budaj, E.P. Gurfinkel, and T.D. Henry
Issues in antithrombin therapy for UA/NSTEMI
Eur. Heart J. Suppl., August 1, 2001; 3(suppl_J): J15 - J23.
[Abstract] [PDF]

Home page
 NEJMHome page
C. P. Cannon, W. S. Weintraub, L. A. Demopoulos, R. Vicari, M. J. Frey, N. Lakkis, F.-J. Neumann, D. H. Robertson, P. T. DeLucca, P. M. DiBattiste, et al.
Comparison of Early Invasive and Conservative Strategies in Patients with Unstable Coronary Syndromes Treated with the Glycoprotein IIb/IIIa Inhibitor Tirofiban
N. Engl. J. Med., June 21, 2001; 344(25): 1879 - 1887.
[Abstract] [Full Text] [PDF]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement