American Heart Journal
Volume 148, Issue 5 , Pages 776-782 , November 2004

Prognostic value of low-level cardiac troponin-I elevations in patients without definite acute coronary syndromes

  • Michael X. Pham, MD, MPH

      Affiliations

    • General Internal Medicine Section, Veterans Affairs Medical Center, and the Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif, USA
    • Corresponding Author InformationReprint requests: Michael X. Pham, MD, MPH, Cardiology Section (111c), VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA.
    • ,
  • Mary A. Whooley, MD

      Affiliations

    • General Internal Medicine Section, Veterans Affairs Medical Center, and the Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif, USA
    • ,
  • G.Thomas Evans Jr, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, University of California, San Francisco, Calif, USA
    • Dr Evans is deceased.
    • ,
  • Catherine Liu, MD

      Affiliations

    • General Internal Medicine Section, Veterans Affairs Medical Center, and the Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif, USA
    • ,
  • Homeira Emadi, MD

      Affiliations

    • General Internal Medicine Section, Veterans Affairs Medical Center, and the Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif, USA
    • ,
  • Winnie Tong, MD

      Affiliations

    • General Internal Medicine Section, Veterans Affairs Medical Center, and the Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif, USA
    • ,
  • M.Catherine Murphy, MD

      Affiliations

    • General Internal Medicine Section, Veterans Affairs Medical Center, and the Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif, USA
    • ,
  • Kirsten E. Fleischmann, MD, MPH, FACC

      Affiliations

    • Division of Cardiology, Department of Medicine, University of California, San Francisco, Calif, USA

Received 9 February 2004 ,Accepted 11 March 2004.

References 

  1. Adams JE, Bodor GS, Davila-Roman VG, et al.  Cardiac troponin I (a marker with high specificity for cardiac injury). Circulation. 1993;88:101–106
  2. Penttila K, Penttila I, Bonnell R, et al.  Comparison of the troponin T and troponin I ELISA tests, as measured by microplate immunoassay techniques, in diagnosing acute myocardial infarction. Eur J Clin Chem Clin Biochem. 1997;35:767–774
  3. Antman EM, Tanasijevic MJ, Thompson B, et al.  Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335:1342–1349
  4. Galvani M, Ottani F, Ferrini D, et al.  Prognostic influence of elevated values of cardiac troponin I in patients with unstable angina. Circulation. 1997;95:2053–2059
  5. Kontos MC, Anderson FP, Alimard R, et al.  Ability of troponin I to predict cardiac events in patients admitted from the emergency department. J Am Coll Cardiol. 2000;36:1818–1823
  6. Morrow DA, Rifai N, Tanasijevic MJ, et al.  Clinical efficacy of three assays for cardiac troponin I for risk stratification in acute coronary syndromes (a Thrombolysis In Myocardial Infarction (TIMI) 11B Substudy). Clin Chem. 2000;46:453–460
  7. Heidenreich PA, Allogiamento T, Melsop K, et al.  The prognostic value of troponin in patients with non-ST elevation acute coronary syndromes (a meta-analysis). J Am Coll Cardiol. 2001;38:478–485
  8. Morrow DA, Cannon CP, Rifai N, et al.  Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction. JAMA. 2001;286:2405–2412
  9. Heeschen C, Hamm CW, Goldmann B, et al.  Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. Lancet. 1999;354:1757–1762
  10. Morrow DA, Antman EM, Tanasijevic M, et al.  Cardiac troponin I for stratification of early outcomes and the efficacy of enoxaparin in unstable angina (a TIMI-11B substudy). J Am Coll Cardiol. 2000;36:1812–1817
  11. Barasch E, Kaushik V, Gupta R, et al.  Elevated cardiac troponin levels do not predict adverse outcomes in hospitalized patients without clinical manifestations of acute coronary syndromes. Cardiology. 2000;93:1–6
  12. Khan IA, Tun A, Wattanasauwan N, et al.  Elevation of serum cardiac troponin I in noncardiac and cardiac diseases other than acute coronary syndromes. Am J Emerg Med. 1999;17:225–229
  13. Guest TM, Ramanathan AV, Tuteur PG, et al.  Myocardial injury in critically ill patients (a frequently unrecognized complication). JAMA. 1995;273:1945–1949
  14. Kollef MH, Ladenson JH, Eisenberg PR. Clinically recognized cardiac dysfunction (an independent determinant of mortality among critically ill patients). Chest. 1997;111:1340–1347
  15. Arlati S, Brenna S, Prencipe L, et al.  Myocardial necrosis in ICU patients with acute non-cardiac disease (a prospective study). Intensive Care Med. 2000;26:31–37
  16. Wright SA, Sawyer DB, Sacks DB, et al.  Elevation of troponin I levels in patients without evidence of myocardial injury. JAMA. 1997;278:2144
  17. Ammann P, Maggiorini M, Bertel O, et al.  Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes. J Am Coll Cardiol. 2003;41:2004–2009
  18. Cohen M, Demers C, Gurfinkel EP, et al.  A comparison of low molecular weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med. 1997;1997:447–452
  19. Bodor GS, Porter S, Landt Y, et al.  Development of monoclonal antibodies for an assay of cardiac troponin-I and preliminary results in suspected cases of myocardial infarction. Clin Chem. 1992;38:2203–2214
  20. Adams JE, Davila-Roman VG, Bessey PQ, et al.  Improved detection of cardiac contusion with cardiac troponin I. Am Heart J. 1996;131:308–312
  21. Del Carlo CH, O'Connor CM. Cardiac troponins in congestive heart failure. Am Heart J. 1999;138:646–653
  22. Missov E, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation. 1997;96:2953–2958
  23. Smith SC, Ladenson JH, Mason JW, Jaffe AS. Elevations of cardiac troponin I associated with myocarditis (experimental and clinical correlates). Circulation. 1997;95:163–168
  24. Mori F, Zuppiroli A, Ognibene A, et al.  Cardiac contusion in blunt chest trauma (a combined study of transesophageal echocardiography and cardiac troponin I determination). Ital Heart J. 2001;2:227
  25. Dixit S, Castle M, Velu RP, et al.  Cardiac involvement in patients with acute neurologic disease (confirmation with cardiac troponin I). Arch Intern Med. 2000;160:3153–3158
  26. Quinn MJ, Moliterno DJ. Troponins in acute coronary syndromes (more TACTICS for an early invasive strategy). JAMA. 2001;286:2461–2462
  27. Fitzmaurice TF, Brown C, Rifai N, et al.  False increase of cardiac troponin I with heterophilic antibodies. Clin Chem. 1998;44:2212–2214
  28. Jaffe AS. Testing the wrong hypothesis (the failure to recognize the limitations of troponin assays). J Am Coll Cardiol. 2001;38:999–1001
  29. Pedersen TR. The Norwegian Multicenter Study of Timolol After Myocardial Infarction. Circulation. 1983;67(suppl I):I.49, 53
  30. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994;344:1383–9
  31. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels: the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med 1998;339:1349–57
  32. Lewis SJ, Moye LA, Sacks FM, et al.  Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range (results of the Cholesterol and Recurrent Events (CARE) trial). Ann Intern Med. 1998;129:681–689
  33. Wallentin LC. Aspirin (75 mg/day) after an episode of unstable coronary artery disease (long-term effects on the risk for myocardial infarction, occurrence of severe angina and the need for revascularization: Research Group on Instability in Coronary Artery Disease in Southeast Sweden). J Am Coll Cardiol. 1991;18:1587–1593
  34. Nyman I, Larsson H, Wallentin L. Prevention of serious cardiac events by low-dose aspirin in patients with silent myocardial ischaemia (the Research Group on Instability in Coronary Artery Disease in Southeast Sweden). Lancet. 1992;340:497–501
  35. Investigators THOPES . Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–153
  36. Cleland JG, Erhardt L, Murray G, et al.  Effect of ramipril on morbidity and mode of death among survivors of acute myocardial infarction with clinical evidence of heart failure (a report from the AIRE Study Investigators). Eur Heart J. 1997;18:3–4

☆ Dr Whooley is supported by the Department of Veterans Affairs Health Services Research and Development Service (Advanced Research Career Development Award), the Robert Wood Johnson Foundation (Generalist Physician Faculty Scholars Program), and the American Federation for Aging Research (Paul Beeson Faculty Scholars in Aging Research Program).

PII: S0002-8703(04)00288-1

doi: 10.1016/j.ahj.2004.03.058

American Heart Journal
Volume 148, Issue 5 , Pages 776-782 , November 2004

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