Risk stratification with a point-of-care cardiac troponin T test in acute myocardial infarction. GUSTOIII Investigators. Global Use of Strategies To Open Occluded Coronary Arteries.
Troponin T has been used successfully to risk stratify patients with acute coronary syndromes, but the utility of this approach using a rapid bedside assay in patients undergoing thrombolysis for ST-segment elevation acute myocardial infarction has not been assessed in a large population. We assessed whether a point-of-care, qualitative troponin T test at enrollment could independently risk-stratify patients randomized to receive alteplase or reteplase in the GUSTO-III trial. Complete troponin T data were available for 12,666 patients (84%) enrolled at 550 hospitals. The primary end point was mortality at 30 days, and the predictive ability of an elevated baseline troponin T level was analyzed (after adjustment for baseline characteristics) with multiple logistic regression. Patients with an elevated troponin T result at enrollment (8.9%) had significantly higher mortality at 30 days (unadjusted 15.7% vs 6.2% for negative patients; p = 0.001), which persisted even after adjustment for age, heart rate, location of infarction, Killip class, and systolic blood pressure. In a multivariable regression model, a positive troponin T result added independently to the prediction of 30-day mortality (chi-square 46, p = 0.001). A positive result with qualitative troponin T testing on admission is an independent marker of higher 30-day mortality. Troponin T testing could be a valuable addition to the evaluation strategy for patients with acute myocardial infarction.
Ohman
E M
EM
Duke Clinical Research Institute, Durham, North Carolina 27715, USA. ohman001@mc.duke.edu
Armstrong
P W
PW
White
H D
HD
Granger
C B
CB
Wilcox
R G
RG
Weaver
W D
WD
Gibler
W B
WB
Stebbins
A L
AL
Cianciolo
C
C
Califf
R M
RM
Topol
E J
EJ
D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D019095:Point-of-Care Systems; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D020107:Troponin T / Q000097:blood*; D014481:United States / Q000453:epidemiology
D015415:Biomarkers; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D020107:Troponin T; D006493:Heparin; C087896:reteplase; D010959:Tissue Plasminogen Activator; D001241:Aspirin