Author + information
- Received June 19, 1997
- Revision received September 29, 1997
- Accepted October 13, 1997
- Published online February 1, 1998.
- Elliott M. Antman, MD, FACCA,* (, )
- David B. Sacks, MDA,
- Nader Rifai, PhDB,
- Carolyn H. McCabe, BSA,
- Christopher P. Cannon, MD, FACCA and
- Eugene Braunwald, MD, FACCA
- ↵*Dr. Elliott M. Antman, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115.
Objectives. We sought to determine whether the rapid bedside assay for troponin T identified patients at risk for a more complicated hospital stay and a higher rate of adverse clinical events.
Background. In patients with an acute coronary syndrome, the amount of cardiac-specific troponin T released bears a stoichiometric relation to the extent of myocardial damage.
Methods. In 597 patients with unstable angina or non–Q wave myocardial infarction participating in the Thrombolysis in Myocardial Infarction (TIMI) 11A substudy, a rapid bedside assay and simultaneous quantitative serum measurement for troponin T were obtained at enrollment.
Results. The composite end point of the sum of death, nonfatal myocardial infarction or recurrent ischemia through day 14 occurred in 33.6% of patients with a positive assay compared with only 22.5% of patients with a negative assay (p = 0.01). Those patients in whom the rapid assay became positive in ≤10 min had the highest mortality rate of 4.2% through day 14 compared with 1.1% in those patients who had either a late-appearing positive assay (>10 min) or a negative assay. The duration of hospital stay in the 116 patients (19%) with a positive rapid assay at enrollment was a median of 5 days compared with only 3 days in the 481 patients (81%) with a negative rapid assay at enrollment (p = 0.002).
Conclusions. A positive rapid assay for troponin T at presentation identifies those patients at risk for higher rates of adverse clinical events and longer, more complicated hospital stays. Stratification of patients by time to development of a positive rapid assay identifies those patients at highest mortality risk.
☆ This study was supported in part by Boehringer Mannheim Corp., Indianapolis, Indiana and Rhone-Poulenc Rorer, Collegeville, Pennsylvania.
- Received June 19, 1997.
- Revision received September 29, 1997.
- Accepted October 13, 1997.
- The American College of Cardiology