Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction.
BACKGROUND
Among patients with suspected acute coronary syndromes, cardiac troponin T levels have prognostic value. However, there is concern that renal dysfunction may impair the prognostic value, because cardiac troponin T may be cleared by the kidney.


METHODS
We analyzed the outcomes in 7033 patients enrolled in the Global Use of Strategies to Open Occluded Coronary Arteries IV trial who had complete base-line data on troponin T levels and creatinine clearance rates. The troponin T level was considered abnormal if it was 0.1 ng per milliliter or higher, and creatinine clearance was assessed in quartiles. The primary end point was a composite of death or myocardial infarction within 30 days.


RESULTS
Death or myocardial infarction occurred in 581 patients. Among patients with a creatinine clearance above the 25th percentile value of 58.4 ml per minute, an abnormally elevated troponin T level was predictive of an increased risk of myocardial infarction or death (7 percent vs. 5 percent; adjusted odds ratio, 1.7; 95 percent confidence interval, 1.3 to 2.2; P<0.001). Among patients with a creatinine clearance in the lowest quartile, an elevated troponin T level was similarly predictive of increased risk (20 percent vs. 9 percent; adjusted odds ratio, 2.5; 95 percent confidence interval, 1.8 to 3.3; P<0.001). When the creatinine clearance rate was considered as a continuous variable and age, sex, ST-segment depression, heart failure, previous revascularization, diabetes mellitus, and other confounders had been accounted for, elevation of the troponin T level was independently predictive of risk across the entire spectrum of renal function.


CONCLUSIONS
Cardiac troponin T levels predict short-term prognosis in patients with acute coronary syndromes regardless of their level of creatinine clearance.
Aviles
Ronnier J
RJ
Department of Cardiology, the Cleveland Clinic Foundation, Cleveland, OH 44951, USA.
Askari
Arman T
AT
Lindahl
Bertil
B
Wallentin
Lars
L
Jia
Gang
G
Ohman
E Magnus
EM
Mahaffey
Kenneth W
KW
Newby
L Kristin
LK
Califf
Robert M
RM
Simoons
Maarten L
ML
Topol
Eric J
EJ
Berger
Peter
P
Lauer
Michael S
MS
D000077284:Abciximab; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015415:Biomarkers; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D017202:Myocardial Ischemia / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000150:complications* / Q000378:metabolism*; D016019:Survival Analysis; D020107:Troponin T / Q000378:metabolism*
D000911:Antibodies, Monoclonal; D015415:Biomarkers; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D020107:Troponin T; D003404:Creatinine; D001241:Aspirin; D000077284:Abciximab