Annals of Emergency Medicine
Volume 45, Issue 4 , Pages 355-362 , April 2005

Influence of Timing of Troponin Elevation on Clinical Outcomes and Use of Evidence-Based Therapies for Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

Received 18 August 2004 ,Revised 8 October 2004 ,Accepted 12 October 2004.

References 

  1. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guidelines for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Unstable Angina). Circulation. 2000;102:1193–1209
  2. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guidelines for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Unstable Angina): summary article. J Am Coll Cardiol. 2002;40:1366–1374
  3. Newby LK, Christenson RH, Ohman EM, et al. Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes. Circulation. 1998;98:1853–1859
  4. Antman EM, Sacks DB, Rifai N, et al. Time to positivity of a rapid bedside assay for cardiac-specific troponin T predicts prognosis in acute coronary syndromes: a Thrombolysis in Myocardial Infarction (TIMI) 11A substudy. J Am Coll Cardiol. 1998;31:326–330
  5. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22
  6. Boersma E, Pieper KS, Steyerberg EW, et al. Predictors of outcome in patients with acute coronary syndromes without persistent ST-segment elevation: results from an international trial of 9,461 patients. Circulation. 2000;101:2557–2567
  7. Kontos MC, Fritz LM, Anderson FP, et al. Impact of troponin standard on the prevalence of acute myocardial infarction. Am Heart J. 2003;146:446–452
  8. Thygesen K, Alpert JS. Myocardial infarction redefined: a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. J Am Coll Cardiol. 2000;36:959–968
  9. Antman EM. Troponin measurements in ischemic heart disease: more than just a black and white picture?. J Am Coll Cardiol. 2001;38:987–990
  10. White HD. Things ain't what they used to be: impact of a new definition of myocardial infarction. Am Heart J. 2002;144:933–937
  11. Kontos MC, Shah R, Fritz LM, et al. Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients. J Am Coll Cardiol. 2004;43:958–965
  12. Newby L, Ohman E, Christenson R, et al. Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin T-positive status: the PARAGON-B troponin T substudy. Circulation. 2001;103:2891–2896
  13. Morrow DA, Antman EM, Tanasijevic M, et al. Cardiac troponin I for stratification of early outcomes and the efficacy of enoxaparin in unstable angina: a TIMI-IIB substudy. J Am Coll Cardiol. 2000;36:1812–1817
  14. Morrow DA, Cannon CP, Rifai N, 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. 2001;286:2405–2412
  15. Sharis PJ, Cannon CP, Rogers WJ, et al. Predictors of mortality, coronary angiography, and revascularization in unstable angina pectoris and acute non–ST elevation myocardial infarction (the TIMI III Registry). Am J Cardiol. 2002;90:1154–1156
  16. Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 1999;340:618–626
  17. Januzzi JL, Cannon CP, DiBattiste PM, et al. Effects of renal insufficiency on early invasive management in patients with acute coronary syndromes (the TACTICS-TIMI 18 Trial). Am J Cardiol. 2002;90:1246–1249
  18. Keeley EC, Kadakia R, Soman S, et al. Analysis of long-term survival after revascularization in patients with chronic kidney disease presenting with acute coronary syndromes. Am J Cardiol. 2003;92:509–551
  19. Aviles RJ, Askari AT, Lindahl B, et al. Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl J Med. 2002;346:2047–2052
  20. Allen LA, O'Donnell CJ, Guigliano RP. Care concordant with guidelines predicts decreased long-term mortality in patients with unstable angina pectoris and non–ST-elevation myocardial infarction. Am J Cardiol. 2004;93:1218–1222
  21. Mukherjee D, Fang J, Chetcuti S, et al. Impact of combination evidence-based medical therapy on mortality in patients with acute coronary syndromes. Circulation. 2004;109:745–749
  22. Peterson ED, Roe MT, Lytle BL, et al. The association between care and outcomes in patients with acute coronary syndromes: national results from CRUSADE. J Am Coll Cardiol. 2004;43:406A

 Author contributions: MTR, EDP, WBG, and EMO conceived the study, designed the study, and obtained research funding. MTR, EDP, and LKN supervised the conduct of the study and data collection. CVP, RHC, WFP, FMF, DD, JDK, and SCS provided input into the study design, interpretation of the data, and writing of the manuscript. YL provided statistical advice on study design and analyzed the data. MTR drafted the manuscript, and all authors contributed substantially to its revision. MTR takes responsibility for the paper as a whole.Funding and support: CRUSADE is funded by Millennium Pharmaceuticals, Inc., and Schering Corporation. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provides an unrestricted grant in support of the program.Reprints not available from the authors.

PII: S0196-0644(04)01555-0

doi: 10.1016/j.annemergmed.2004.10.016

Annals of Emergency Medicine
Volume 45, Issue 4 , Pages 355-362 , April 2005

Article Tools