title: Stress testing and troponin in unstable coronary syndromes: the status trial-clinical outcomes and resource use.
abstract: Cardiac troponins are markers used to diagnose acute myocardial infarction, but their value in guiding management in low- to intermediate-risk patients is not well established. Using a randomized design, the authors compared a strategy using stress testing with blinded troponins vs a troponin I-guided strategy for risk stratification and management of 241 patients with intermediate-risk unstable angina. Fewer stress-tested patients required coronary care unit admission and repeat hospitalization for acute coronary syndrome, at a lower cost. There was no significant difference in rates of death and myocardial infarction due to acute coronary syndrome at 6 months' follow-up. For patients with intermediate-risk acute coronary syndrome, stress testing is as safe as, and more cost-effective than, a troponin I-guided strategy. Patients with marginal troponin I elevations can safely undergo stress testing. Further studies combining stress testing and a troponin I-guided strategy are warranted.
authors.affiliation: Department of Cardiology, Italian Hospital, Buenos Aires, Argentina.
authors.forename: José Navarro
authors.initials: JN
authors.lastname: Estrada
authors.forename: Florencia
authors.initials: F
authors.lastname: Rolandi
authors.forename: Sameer
authors.initials: S
authors.lastname: Bansilal
authors.forename: Paula
authors.initials: P
authors.lastname: Averbuj
authors.forename: Eugenia
authors.initials: E
authors.lastname: Natale
authors.forename: M Urooj
authors.initials: MU
authors.lastname: Zafar
authors.forename: Mugdha
authors.initials: M
authors.lastname: Santra
authors.forename: Josephine
authors.initials: J
authors.lastname: Barbiere
authors.forename: James H
authors.initials: JH
authors.lastname: Chesebro
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D015906:Angioplasty, Balloon, Coronary; D001118:Argentina; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D003325:Coronary Care Units / Q000191:economics; D003362:Cost-Benefit Analysis; D052279:Creatine Kinase, MB Form / Q000097:blood; D004636:Emergency Service, Hospital / Q000191:economics; D005080:Exercise Test / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form