Acute coronary syndromes. The diagnostic role of troponins.
Acute coronary syndromes (ACSs) represent the acute life-threatening phases of coronary heart disease. Clinical symptoms, EKG, and CK-MB measurements are frequently insufficient to evaluate patients without persisting ST elevations. Serial determinations of troponin T or troponin I after arrival in hospital disclose minor myocardial injury in patients presenting as unstable angina. This finding allows the currently best risk stratification and may contribute to cost-effectiveness. Without elevated troponins the risk for death or myocardial infarction during 30 days follow-up is not more than 1%. The lack of elevated troponins does not implicate that these patients do not have coronary artery disease. Patients with positive evidence of troponins represent a high-risk group who should be hospitalized and further evaluated, because the risk for myocardial infarction and death in 30 days is approximately 20%. Current studies indicate that early revascularization under glycoprotein IIb/IIIa antagonists represent the optimal treatment.
Hamm
C W
CW
Kerckhoff Heart Center, Benekestrasse 2-8, D-61231, Bad Nauheim, Germany. christian.hamm@kerckhoff.med.uni-giessen.de
D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D018570:Risk Assessment; D014336:Troponin / Q000097:blood*
D015415:Biomarkers; D014336:Troponin