Stress testing and troponin in unstable coronary syndromes: the status trial-clinical outcomes and resource use.
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.
Estrada
José Navarro
JN
Department of Cardiology, Italian Hospital, Buenos Aires, Argentina.
Rolandi
Florencia
F
Bansilal
Sameer
S
Averbuj
Paula
P
Natale
Eugenia
E
Zafar
M Urooj
MU
Santra
Mugdha
M
Barbiere
Josephine
J
Chesebro
James H
JH
Farkouh
Michael E
ME
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*
D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form