scholarly journals Myeloperoxidase Improves Risk Stratification in Patients with Ischemia and Normal Cardiac Troponin I Concentrations

2011 ◽  
Vol 57 (4) ◽  
pp. 603-608 ◽  
Author(s):  
Fred S Apple ◽  
Stephen W Smith ◽  
Lesly A Pearce ◽  
Karen M Schulz ◽  
Ranka Ler ◽  
...  
Keyword(s):  
Cardiac Troponin ◽  
Troponin I ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Cardiac Troponin I ◽  
Rank Statistic ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Patients At Risk

BACKGROUND We assessed the ability of myeloperoxidase (MPO) to identify the risk for major adverse cardiac events (MACE) in patients who present with ischemic symptoms suggestive of acute coronary syndrome and have a normal cardiac troponin I (cTnI) value. METHODS We used Siemens (n = 400) and Abbott (n = 350) assays to measure MPO and cTnI in plasma samples from 400 patients. Event rates (myocardial infarction, cardiac death, percutaneous coronary intervention, coronary artery bypass grafting) were estimated by the Kaplan–Meier method and compared with the log-rank statistic. RESULTS At the 30-day follow-up, the adjusted hazard ratios for MACE were 3.9 (P < 0.001) for increased cTnI and 2.7 (P = 0.006) for increased MPO for the Siemens assays and were 5.5 (P < 0.001) for increased cTnI and 2.9 (P = 0.001) for increased MPO for the Abbott assays. Similar findings were observed with 6 months of follow-up. Patients who initially had a normal cTnI value and an increased Siemens MPO value demonstrated a higher rate of MACE at 30 days than those in whom both values were normal (16.1% vs 3.6%, P = 0.002) and 6 months (18.1% vs 5.0%, P = 0.002). Similarly, patients who had an increased Abbott MPO result demonstrated a higher MACE rate at 30 days (12.3% vs 3.9%, P = 0.03) and at 6 months (16.2% vs 5.1%, P = 0.01) than those with normal values. CONCLUSIONS A combination of MPO and cTnI allowed the identification of a greater proportion of patients at risk for MACE than the use of cTnI alone. Increased MPO values remained predictive of future cardiac events even when the cTnI value was normal.

scholarly journals Role of Monitoring Changes in Sensitive Cardiac Troponin I Assay Results for Early Diagnosis of Myocardial Infarction and Prediction of Risk of Adverse Events

2009 ◽  
Vol 55 (5) ◽  
pp. 930-937 ◽  
Author(s):  
Fred S Apple ◽  
Lesly A Pearce ◽  
Stephen W Smith ◽  
Jason M Kaczmarek ◽  
MaryAnn M Murakami
Keyword(s):  
Myocardial Infarction ◽  
Adverse Events ◽  
Cardiac Troponin ◽  
Cardiac Event ◽  
Troponin I ◽  
Artery Bypass ◽  
Cardiac Troponin I ◽  
Coronary Artery Bypass Grafts ◽  
Coronary Syndrome

Abstract Background: We sought to determine the diagnostic accuracy of the cardiac troponin I (cTnI) VITROS® Troponin I-ES assay for early detection of acute myocardial infarction (AMI) and for risk prediction of adverse events in patients with symptoms of acute coronary syndrome (ACS). Methods: cTnI was measured on admission and approximately 6 h postadmission in 381 patients. The 99th percentile cTnI concentration (0.034 μg/L) and change [delta (δ)] between admission and follow-up concentrations were evaluated in diagnostic sensitivity and specificity calculations. Risk of cardiac event or death within 60 days was evaluated by Cox proportional hazards regression. Results: AMI occurred in 52 patients. Diagnostic sensitivities (95% CI) of admission and follow-up cTnIs for AMI were 69% (55%–81%) and 94% (84%–99%), respectively. The corresponding specificities (95% CI) were 78% (73%–82%) and 81% (77%–85%), and ROC curve areas were 0.82 vs 0.96 (P < 0.001). Deltas between admission and follow-up cTnI >30% had a sensitivity of 75% (95% CI 61%–86%) and a specificity of 91% (95% CI 87%–94%). During follow-up, 1 cardiac death, 2 noncardiac deaths, 52 AMIs, 6 coronary artery bypass grafts, and 43 percutanous coronary interventions occurred in 62 patients. A δ cTnI >30%, when added to either initial cTnI >0.034 μg/L or follow-up cTnI >0.034 μg/L, improved risk stratification for cardiac event or death (P < 0.001). Conclusions: Admission cTnI measured by the VITROS ES assay is a sensitive biomarker for detection of AMI. Utilizing >30% cTnI δ in addition to either the baseline or follow-up concentration improved both specificity and risk assessment in patients presenting with symptoms of ACS.

Prognostic Value of Troponin I with Echocardiography Assessment in Septic Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sherif Farouk Ibrahim ◽  
Ashraf Elsayed Elagmy ◽  
Abdelrhman Gamal Abdelsabour
Keyword(s):  
Septic Shock ◽  
Acute Coronary Syndrome ◽  
Intensive Care ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Coronary Syndrome ◽  
Sepsis And Septic Shock

Abstract Background Sepsis is heterogenous with regard to factors such as causal microorganism, patient predisposition, co-morbidity and response to therapy, a key element and unifying feature is the manifestation of cardiovascular dysfunction. Elevated concentrations of cardiac troponin I (cTnI) are frequently observed in patients with severe sepsis and septic shock even in the absence of an acute coronary syndrome (ACS). Objective To evaluate the prognostic value of (cTnI) with echocardiography assessment in septic patients. Patients and Methods This study was conducted at the intensive care units of Ain Shams university hospitals. 20 patients of both sexes with age ranging from 18 to 70 years diagnosed with sepsis admitted to Intensive care unit were included in prospective observational study. Results Baseline cTnI had a significant positive correlation with follow up troponine (p = 0.0016). Baseline EF had a significant negative correlation with follow up troponine (p = 0.036). Using ROC-curve analysis, troponin level at a cutoff point (>1.9) predicted patients with mortality, with good (87%) accuracy, sensitivity= 90% and specificity= 90% (p < 0.01). Conclusion Elevated concentrations of cardiac troponin I (cTnI) are frequently observed in patients with sepsis and septic shock even in the absence of an acute coronary syndrome.

scholarly journals P3648Detailed temporal patterns of high-sensitivity-cardiac troponin I and T during long-term follow-up after acute coronary syndrome

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
V.J. Van Den Berg ◽  
V.A.W.M. Umans ◽  
K.M. Akkerhuis ◽  
R.M. Oemrawsingh ◽  
F.W. Asselbergs ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Troponin ◽  
Troponin I ◽  
High Sensitivity ◽  
Temporal Patterns ◽  
Cardiac Troponin I ◽  
Coronary Syndrome ◽  
Long Term Follow Up

scholarly journals Use of the Centaur TnI-Ultra Assay for Detection of Myocardial Infarction and Adverse Events in Patients Presenting With Symptoms Suggestive of Acute Coronary Syndrome

2008 ◽  
Vol 54 (4) ◽  
pp. 723-728 ◽  
Author(s):  
Fred S Apple ◽  
Stephen W Smith ◽  
Lesly A Pearce ◽  
Ranka Ler ◽  
MaryAnn M Murakami
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Troponin I ◽  
Artery Bypass ◽  
Roc Curves ◽  
Coronary Artery Bypass Grafts ◽  
Rank Statistic ◽  
Coronary Syndrome

Abstract Background: We determined the diagnostic accuracy of the Advia Centaur TnI-Ultra assay for detecting myocardial infarction (MI) and assessing risk of adverse events in patients presenting with ischemic symptoms suggestive of acute coronary syndrome. Methods: We measured cardiac troponin I (cTnI) on admission and 6–24 h after admission (follow-up) in plasma specimens from 371 consecutive patients. The end point was the first of cardiac event or death within 60 days. We estimated survival curves using the Kaplan-Meier method and compared groups with the log rank statistic. Results: MI was established in 49 patients (13%). Clinical sensitivities and specificities for MI based on the 99th percentile (0.04 μg/L) were 74% and 84%, respectively, on admission and 94% and 81% at follow-up. ROC curves showed significantly higher accuracy for MI in the follow-up specimen compared with admission (P = 0.001). Overall there were 2 cardiac deaths, 1 noncardiac death, 49 MIs, 7 coronary artery bypass grafts, and 36 percutaneous coronary interventions in 59 patients during follow-up. The event rate in those with cTnI <0.006 μg/L was significantly lower than in groups with cTnI 0.006–0.04 μg/L, >0.04–0.10 μg/L, or >0.10 μg/L (2.8% vs 11.1%, 24.1%, 55.1%, respectively; P <0.0001). Relative risks for the increasing cTnI cutoff groups were 3.9 (95% CI 1.2–13), 8.9 (2.4–34), and 25 (7.3–82) after adjustment for age, diabetes, history of hypertension, previous MI, and estimated glomerular filtration rate. Conclusions: The TnI-Ultra assay is a sensitive, early diagnostic biomarker for MI and an independent predictor of adverse events at any measurable cTnI in patients with symptoms of acute coronary syndrome.

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