PDF herunterladen
Int J Angiol 2016; 25(01): 054-063
DOI: 10.1055/s-0035-1547396
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predictors of Peak Troponin Level in Acute Coronary Syndromes: Prior Aspirin Use and SYNTAX Score

Hemal A. Bhatt
1   Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York
,
Dharmesh R. Sanghani
1   Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York
,
David Lee
1   Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York
,
Kell N. Julliard
1   Department of Internal Medicine, Lutheran Medical Center, Brooklyn, New York
,
George A. Fernaine
2   Department of Cardiology, Lutheran Medical Center, Brooklyn, New York
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
23. März 2015 (online)

   Lizenzen und Reprints

Abstract

The peak troponin level has been associated with cardiovascular (CV) mortality and adverse CV events. The association of peak troponin with CV risk factors and severity and complexity of coronary artery disease remains unknown. We assessed the predictors of peak troponin in patients with acute coronary syndrome (ACS). This study aims to determine the predictors of peak troponin in ACS. Cardiac catheterization (CC) reports and electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 219 patients were eligible for the study. All major CV risk factors, comorbidities, laboratory data, CC indications, and coronary lesion characteristics were included. Univariate and multivariate regression analyses were done. On multivariate linear regression analysis, ST-elevation myocardial infarction (p = 0.001, β = 65.16) and increasing synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score (p = 0.002, β = 1.15) were associated with higher peak troponin. The Pearson correlation between SYNTAX score and peak troponin was r = 0.257, p = 0.001. History of daily aspirin use was associated with lower peak troponin (p = 0.002, β = −24.32). Prior statin use (p = 0.321, β = −8.98) and the presence of CV risk factors were not associated with peak troponin. Coronary artery disease severity and complexity, urgency of CC, and prior aspirin use are associated with peak troponin levels in ACS. Our findings may help predict patient population with ACS who would be at a greater risk for short- and long-term CV morbidity and mortality due to elevated peak troponin.

Keywords

SYNTAX - troponin - acute coronary syndromes - aspirin - statin - STEMI - coronary artery disease - cardiovascular

Note

All authors made substantial contributions to the following: (1) conception and design, or acquisition of data, or analysis and interpretation of data; (2) drafting the article; and (3) final approval of the version to be published.


 

  • References

  • 1 Kumar A, Cannon CP. Acute coronary syndromes: diagnosis and management, part I. Mayo Clin Proc 2009; 84 (10) 917-938
    CrossrefPubMedGoogle Scholar
  • 2 Daubert MA, Jeremias A. The utility of troponin measurement to detect myocardial infarction: review of the current findings. Vasc Health Risk Manag 2010; 6: 691-699
    PubMedGoogle Scholar
  • 3 Antman EM, Morrow DA. Biomarker release after percutaneous coronary intervention: a message from the heart. Circ Cardiovasc Interv 2008; 1 (1) 3-6
    CrossrefPubMedGoogle Scholar
  • 4 de Winter RJ, Tijssen JG. Non-ST-segment elevation myocardial infarction: revascularization for everyone?. JACC Cardiovasc Interv 2012; 5 (9) 903-905
    CrossrefPubMedGoogle Scholar
  • 5 Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation 2000; 102 (1) 118-122
    CrossrefPubMedGoogle Scholar
  • 6 Tricoci P, Leonardi S, White J , et al. Cardiac troponin after percutaneous coronary intervention and 1-year mortality in non-ST-segment elevation acute coronary syndrome using systematic evaluation of biomarker trends. J Am Coll Cardiol 2013; 62 (3) 242-251
    CrossrefPubMedGoogle Scholar
  • 7 Chin CT, Wang TY, Li S , et al. Comparison of the prognostic value of peak creatine kinase-MB and troponin levels among patients with acute myocardial infarction: a report from the Acute Coronary Treatment and Intervention Outcomes Network Registry-get with the guidelines. Clin Cardiol 2012; 35 (7) 424-429
    CrossrefPubMedGoogle Scholar
  • 8 Kontos MC, Shah R, Fritz LM , et al. Implication of different cardiac troponin I levels for clinical outcomes and prognosis of acute chest pain patients. J Am Coll Cardiol 2004; 43 (6) 958-965
    CrossrefPubMedGoogle Scholar
  • 9 Boden H, Ahmed TA, Velders MA , et al. Peak and fixed-time high-sensitive troponin for prediction of infarct size, impaired left ventricular function, and adverse outcomes in patients with first ST-segment elevation myocardial infarction receiving percutaneous coronary intervention. Am J Cardiol 2013; 111 (10) 1387-1393
    CrossrefPubMedGoogle Scholar
  • 10 Byrne RA, Ndrepepa G, Braun S , et al. Peak cardiac troponin-T level, scintigraphic myocardial infarct size and one-year prognosis in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol 2010; 106 (9) 1212-1217
    CrossrefPubMedGoogle Scholar
  • 11 Frey N, Dietz A, Kurowski V , et al. Angiographic correlates of a positive troponin T test in patients with unstable angina. Crit Care Med 2001; 29 (6) 1130-1136
    CrossrefPubMedGoogle Scholar
  • 12 Jurlander B, Farhi ER, Banas Jr JJ , et al. Coronary angiographic findings and troponin T in patients with unstable angina pectoris. Am J Cardiol 2000; 85 (7) 810-814
    CrossrefPubMedGoogle Scholar
  • 13 Capodanno D, Capranzano P, Di Salvo ME , et al. Usefulness of SYNTAX score to select patients with left main coronary artery disease to be treated with coronary artery bypass graft. JACC Cardiovasc Interv 2009; 2 (8) 731-738
    PubMedGoogle Scholar
  • 14 Head SJ, Farooq V, Serruys PW, Kappetein AP. The SYNTAX score and its clinical implications. Heart 2014; 100 (2) 169-177
    CrossrefPubMedGoogle Scholar
  • 15 Sianos G, Morel MA, Kappetein AP , et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1 (2) 219-227
    Google Scholar
  • 16 Girasis C, Garg S, Räber L , et al. SYNTAX score and Clinical SYNTAX score as predictors of very long-term clinical outcomes in patients undergoing percutaneous coronary interventions: a substudy of SIRolimus-eluting stent compared with pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial. Eur Heart J 2011; 32 (24) 3115-3127
    CrossrefPubMedGoogle Scholar
  • 17 Palmerini T, Genereux P, Caixeta A , et al. Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage StrategY) trial. J Am Coll Cardiol 2011; 57 (24) 2389-2397
    CrossrefPubMedGoogle Scholar
  • 18 Davies MJ. The pathophysiology of acute coronary syndromes. Heart 2000; 83 (3) 361-366
    CrossrefPubMedGoogle Scholar
  • 19 Gonzalez MA, Porterfield CP, Eilen DJ , et al; Multidisciplinary Atherothrombosis Prevention Program (MAPP). Quartiles of peak troponin are associated with long-term risk of death in type 1 and STEMI, but not in type 2 or NSTEMI patients. Clin Cardiol 2009; 32 (10) 575-583
    CrossrefPubMedGoogle Scholar
  • 20 Antman EM. Troponin measurements in ischemic heart disease: more than just a black and white picture. J Am Coll Cardiol 2001; 38 (4) 987-990
    CrossrefPubMedGoogle Scholar
  • 21 Laufer EM, Mingels AM, Winkens MH , et al. The extent of coronary atherosclerosis is associated with increasing circulating levels of high sensitive cardiac troponin T. Arterioscler Thromb Vasc Biol 2010; 30 (6) 1269-1275
    CrossrefPubMedGoogle Scholar
  • 22 Lindahl B, Diderholm E, Lagerqvist B, Venge P, Wallentin L ; FRISC II(Fast Revascularization during InStability in CAD) Investigators. Mechanisms behind the prognostic value of troponin T in unstable coronary artery disease: a FRISC II substudy. J Am Coll Cardiol 2001; 38 (4) 979-986
    CrossrefPubMedGoogle Scholar
  • 23 Korosoglou G, Lehrke S, Mueller D , et al. Determinants of troponin release in patients with stable coronary artery disease: insights from CT angiography characteristics of atherosclerotic plaque. Heart 2011; 97 (10) 823-831
    CrossrefPubMedGoogle Scholar
  • 24 Ucar H, Gur M, Seker T , et al. High-Sensitivity Cardiac Troponin T is Associated with SYNTAX Score and Diabetes Mellitus in Patients with Stable Coronary Artery Disease. J Clin Exp Cardiolog. 2013; 4 (9) 1-5
    PubMedGoogle Scholar
  • 25 Mekontso Dessap A, Lellouche N, Audard V , et al. Effect of renal failure on peak troponin Ic level in patients with acute myocardial infarction. Cardiology 2008; 109 (4) 217-221
    CrossrefPubMedGoogle Scholar
  • 26 Donaldson A, Cove-Smith R. Cardiac troponin levels in patients with impaired renal function. Hosp Med 2001; 62 (2) 86-89
    CrossrefPubMedGoogle Scholar
  • 27 Adams GR, Vaziri ND. Skeletal muscle dysfunction in chronic renal failure: effects of exercise. Am J Physiol Renal Physiol 2006; 290 (4) F753-F761
    PubMedGoogle Scholar
  • 28 Agzew Y. Elevated serum cardiac troponin in non-acute coronary syndrome. Clin Cardiol 2009; 32 (1) 15-20
    CrossrefPubMedGoogle Scholar
  • 29 Tsai SH, Lin YY, Chu SJ, Hsu CW, Cheng SM. Interpretation and use of natriuretic peptides in non-congestive heart failure settings. Yonsei Med J 2010; 51 (2) 151-163
    CrossrefPubMedGoogle Scholar
  • 30 Schaper J, Froede R, Hein S , et al. Impairment of the myocardial ultrastructure and changes of the cytoskeleton in dilated cardiomyopathy. Circulation 1991; 83 (2) 504-514
    CrossrefPubMedGoogle Scholar
  • 31 Udell JA, Scirica BM, Braunwald E , et al. Statin and aspirin therapy for the prevention of cardiovascular events in patients with type 2 diabetes mellitus. Clin Cardiol 2012; 35 (12) 722-729
    CrossrefPubMedGoogle Scholar
  • 32 Rich JD, Cannon CP, Murphy SA, Qin J, Giugliano RP, Braunwald E. Prior aspirin use and outcomes in acute coronary syndromes. J Am Coll Cardiol 2010; 56 (17) 1376-1385
    CrossrefPubMedGoogle Scholar
  • 33 Cairns JA, Gent M, Singer J , et al. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med 1985; 313 (22) 1369-1375
    CrossrefPubMedGoogle Scholar
  • 34 Collaborative overview of randomised trials of antiplatelet therapy—I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ 1994; 308 (6921) 81-106
    CrossrefPubMedGoogle Scholar
  • 35 Lewis Jr HD, Davis JW, Archibald DG , et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N Engl J Med 1983; 309 (7) 396-403
    CrossrefPubMedGoogle Scholar
  • 36 Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med 2013; 368 (21) 2004-2013
    CrossrefPubMedGoogle Scholar
  • 37 Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med 1992; 326 (5) 310-318
    CrossrefPubMedGoogle Scholar
  • 38 Massberg S, Schulz C, Gawaz M. Role of platelets in the pathophysiology of acute coronary syndrome. Semin Vasc Med 2003; 3 (2) 147-162
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 39 Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation 2001; 104 (3) 365-372
    CrossrefPubMedGoogle Scholar
  • 40 Kennon S, Barakat K, Hitman GA , et al. Angiotensin-converting enzyme inhibition is associated with reduced troponin release in non-ST-elevation acute coronary syndromes. J Am Coll Cardiol 2001; 38 (3) 724-728
    CrossrefPubMedGoogle Scholar
  • 41 Ruggenenti P, Perna A, Remuzzi G ; Gruppo Italiano di Studi Epidemiologici in Nefrologia. ACE inhibitors to prevent end-stage renal disease: when to start and why possibly never to stop: a post hoc analysis of the REIN trial results. Ramipril Efficacy in Nephropathy. J Am Soc Nephrol 2001; 12 (12) 2832-2837
    PubMedGoogle Scholar
  • 42 Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc Nephrol 2006; 17 (7) 2006-2016
    CrossrefPubMedGoogle Scholar