[Risk stratification in acute coronary syndrome].
BACKGROUND
The spectrum of symptoms of patients with active ischemic heart disease ranges from silent ischemia to acute myocardial infarction and the extent of myocardial damage from reversible myocardial injury to extensive necrosis. The term "acute coronary syndrome" comprises this continuum. In particular the evaluation of patients without ST-segment elevation is difficult, for clinical symptoms, ECG criteria and CK-MB measurements appear insufficient for appropriate risk stratification.
Serial measurements of either troponin T or I reliably detect minor myocardial damage in those patients, who are known to be at a higher risk for adverse cardiac events comparable to the risk of patients with acute myocardial infarction. Hence determination of troponins allow superior risk stratification contributing to early triage and therapeutic decision making. Without elevation of troponins the cardiac risk for death or myocardial infarction will not exceed 1%.


CONCLUSIONS
Patients with elevated troponins should be early hospitalized and further evaluated in order to begin efficacious therapy as soon as possible. These patients represent a high-risk subgroup of patients clinically classified as unstable angina, who might benefit from potential antithrombotic treatment such as low-molecular weight heparin or glycoprotein IIb/IIIa antagonists without or with revascularization strategies.
Goldmann
B U
BU
Universitätskrankenhaus Hamburg-Eppendorf. goldmann@uke.uni-hamburg.de
Hamm
C W
CW
D000077284:Abciximab; D000208:Acute Disease; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D015415:Biomarkers; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D017762:Nadroparin / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D009626:Terminology as Topic; D000077466:Tirofiban; D019210:Troponin I / Q000097:blood; D020107:Troponin T / Q000097:blood; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D015415:Biomarkers; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D017762:Nadroparin; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D019210:Troponin I; D020107:Troponin T; D014443:Tyrosine; D000077466:Tirofiban; D000077284:Abciximab