PMID- 20569707
OWN - NLM
STAT- MEDLINE
DCOM- 20100715
LR  - 20211020
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 159
IP  - 6
DP  - 2010 Jun
TI  - Early dynamic risk stratification with baseline troponin levels and 90-minute 
      ST-segment resolution to predict 30-day cardiovascular mortality in ST-segment 
      elevation myocardial infarction: analysis from CLopidogrel as Adjunctive 
      ReperfusIon TherapY (CLARITY)-Thrombolysis in Myocardial Infarction (TIMI) 28.
PG  - 964-971.e1
LID - 10.1016/j.ahj.2010.03.005 [doi]
AB  - BACKGROUND: Troponin is the preferred biomarker for risk stratification in non-ST 
      elevation ACS. The incremental prognostic use of the initial magnitude of 
      troponin elevation and its value in conjunction with ST-segment resolution 
      (STRes) in ST elevation myocardial infarction (STEMI) is less well defined. 
      METHODS: Troponin T (TnT) was measured in 1,250 patients at presentation 
      undergoing fibrinolysis for STEMI in CLARITY-TIMI 28. ST-segment resolution was 
      measured at 90 minutes. Multivariable logistic regression was used to examine the 
      independent association between TnT levels, STRes, and 30-day cardiovascular (CV) 
      mortality. RESULTS: Patients were classified into undetectable TnT at baseline (n 
      = 594), detectable but below the median of 0.12 ng/mL (n = 330), and above the 
      median (n = 326). Rates of 30-day CV death were 1.5%, 4.5%, and 9.5%, 
      respectively (P < .0001). Compared with those with undetectable levels and 
      adjusting for baseline factors, the odds ratios for 30-day CV death were 4.56 
      (1.72-12.08, P = .002) and 5.81 (2.29-14.73, P = .0002) for those below and above 
      the median, respectively. When combined with STRes, there was a significant 
      gradient of risk, and in a multivariable model both baseline TnT (P = .004) and 
      STRes (P = .003) were significant predictors of 30-day CV death. The addition of 
      TnT and STRes to clinical risk factors significantly improved the C-statistic 
      (from 0.86 to 0.90, P = .02) and the integrated discriminative improvement (7.1% 
      increase) (P = .0009). CONCLUSIONS: Baseline TnT and 90-minute STRes are 
      independent predictors of 30-day CV death in patients with STEMI. Use of these 2 
      simple, readily available tools can aid clinicians in early risk stratification.
CI  - Copyright 2010 Mosby, Inc. All rights reserved.
FAU - Sherwood, Matthew W
AU  - Sherwood MW
AD  - TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's 
      Hospital and Harvard Medical School, Boston, MA 02115, USA.
FAU - Morrow, David A
AU  - Morrow DA
FAU - Scirica, Benjamin M
AU  - Scirica BM
FAU - Jiang, Songtao
AU  - Jiang S
FAU - Bode, Christoph
AU  - Bode C
FAU - Rifai, Nader
AU  - Rifai N
FAU - Gerszten, Robert E
AU  - Gerszten RE
FAU - Gibson, C Michael
AU  - Gibson CM
FAU - Cannon, Christopher P
AU  - Cannon CP
FAU - Braunwald, Eugene
AU  - Braunwald E
FAU - Sabatine, Marc S
AU  - Sabatine MS
LA  - eng
GR  - U01 HL081341/HL/NHLBI NIH HHS/United States
GR  - U01 HL081341-04/HL/NHLBI NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Troponin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
SB  - IM
MH  - Clopidogrel
MH  - Dose-Response Relationship, Drug
MH  - *Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Immunoassay
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/blood/*drug therapy/mortality
MH  - Platelet Aggregation Inhibitors/administration & dosage/*therapeutic use
MH  - Prognosis
MH  - Risk Factors
MH  - Survival Rate
MH  - Thrombolytic Therapy/*methods
MH  - Ticlopidine/administration & dosage/*analogs & derivatives/therapeutic use
MH  - Time Factors
MH  - Treatment Outcome
MH  - Troponin/*blood
PMC - PMC2892399
MID - NIHMS188130
EDAT- 2010/06/24 06:00
MHDA- 2010/07/16 06:00
PMCR- 2011/06/01
CRDT- 2010/06/24 06:00
PHST- 2009/07/31 00:00 [received]
PHST- 2010/03/06 00:00 [accepted]
PHST- 2010/06/24 06:00 [entrez]
PHST- 2010/06/24 06:00 [pubmed]
PHST- 2010/07/16 06:00 [medline]
PHST- 2011/06/01 00:00 [pmc-release]
AID - S0002-8703(10)00229-2 [pii]
AID - 10.1016/j.ahj.2010.03.005 [doi]
PST - ppublish
SO  - Am Heart J. 2010 Jun;159(6):964-971.e1. doi: 10.1016/j.ahj.2010.03.005.