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Troponin: an important prognostic marker and risk-stratification tool in non–ST-segment elevation acute coronary syndromes

L. Kristin Newby, MD, FACC^*, Britta U. Goldmann, MD and E. Magnus Ohman, MD, FACC^,*

^* Duke Clinical Research Institute, Durham, North Carolina, USA
University Hospital Eppendorf, Hamburg, Germany
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

Manuscript received July 9, 2002; revised manuscript received September 16, 2002, accepted October 4, 2002.

^* Reprint requests and correspondence: Dr. E. Magnus Ohman, Professor of Medicine, Chief, Division of Cardiology, University of North Carolina at Chapel Hill, 338 Burnett-Womack Building, CB 7075, Chapel Hill, North Carolina 27599 USA.
mohman{at}med.unc.edu

Over the past decade, there has been a progressive evolution of cardiac marker testing in patients with acute coronary syndromes (ACS). This has not only resulted in a dramatic shift in how we view the diagnosis of myocardial infarction (MI), but it has also extended the role of cardiac marker testing into risk stratification and guidance of treatment decisions. By the year 2000, the development of highly sensitive and cardiac-specific troponin assays had resulted in a consensus change in the definition of MI, placing increased emphasis on cardiac-marker testing with troponins as the new gold standard. Furthermore, and perhaps more importantly, the role of the troponins as superior markers of subsequent cardiac risk in ACS patients became firmly established. Most recently, the supportive role of these markers in identifying patients with ACS who may derive particular benefit from potent anti-thrombotic and anti-platelet therapy or early invasive treatment strategies has been demonstrated. This paper will review the evolution of these important roles of troponin testing for risk stratification in ACS.

Abbreviations and Acronyms   ACS = acute coronary syndrome(s)   CK-MB = creatine kinase-myocardial band   GP = glycoprotein   LMWH = low-molecular-weight heparin   MI = myocardial infarction   NSTE = non–ST-segment elevation   PCI = percutaneous coronary intervention   RR = relative risk

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