title: Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators.
abstract: BACKGROUND
  The prognosis of patients hospitalized with acute myocardial ischemia is quite variable. We examined the value of serum levels of cardiac troponin T, serum creatine kinase MB (CK-MB) levels, and electrocardiographic abnormalities for risk stratification in patients with acute myocardial ischemia.
  
  
  METHODS
  We studied 855 patients within 12 hours of the onset of symptoms. Cardiac troponin T levels, CK-MB levels, and electrocardiograms were analyzed in a blinded fashion at the core laboratory. We used logistic regression to assess the usefulness of baseline levels of cardiac troponin T and CK-MB and the electrocardiographic category assigned at admission-ST-segment elevation, ST-segment depression, T-wave inversion, or the presence of confounding factors that impair the detection of ischemia (bundle-branch block and paced rhythms)-in predicting outcome.
  
  
  RESULTS
  On admission, 289 of 801 patients with base-line serum samples had elevated troponin T levels (> 0.1 ng per milliliter). Mortality within 30 days was significantly higher in these patients than in patients with lower levels of troponin T (11.8 percent vs. 3.9 percent, P < 0.001). The troponin T level was the variable most strongly related to 30-day mortality (chi-square = 21, P < 0.001), followed by the electrocardiographic category (chi-square = 14, P = 0.003) and the CK-MB level (chi-square = 11, P = 0.004). Troponin T levels remained significantly predictive of 30-day mortality in a model that contained the electrocardiographic categories and CK-MB levels (chi-square = 9.2, P = 0.027).
  
  
  CONCLUSIONS
  The cardiac troponin T level is a powerful, independent risk marker in patients who present with acute myocardial ischemia. It allows further stratification of risk when combined with standard measures such as electrocardiography and the CK-MB level.
authors.affiliation: Department of Medicine, Duke University, Durham, N.C., USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Ohman
authors.forename: P W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: R H
authors.initials: RH
authors.lastname: Christenson
authors.forename: C B
authors.initials: CB
authors.lastname: Granger
authors.forename: H A
authors.initials: HA
authors.lastname: Katus
authors.forename: C W
authors.initials: CW
authors.lastname: Hamm
authors.forename: M A
authors.initials: MA
authors.lastname: O'Hanesian
authors.forename: G S
authors.initials: GS
authors.lastname: Wagner
authors.forename: N S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: F E
authors.initials: FE
authors.lastname: Harrell
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007527:Isoenzymes; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000145:classification* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D018709:Statistics, Nonparametric; D014336:Troponin / Q000097:blood*; D020107:Troponin T
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase