Cardiac Troponin

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Cardiac troponin measurements improve MI detection and allow early risk stratification in acute coronary syndromes. In GUSTO IIA (35), 30-d mortality was 13% among

Fig. 3. Prognostic information from ECG patterns. (A and B) From patients without distortion of terminal position of the QRS complex. (C and D) From patients with terminal QRS distortion (emergence of J point at >50% of R-wave in leads with qR configuration or disappearance of S-wave in leads with Rs configuration). Reproduced with permission from ref. 40. (E) From a patient with anterior infarction with additional STE 15 min after initiation of thrombolysis with final resolution suggestive of favorable clinical outcome. Reproduced with permission from ref. 47.

Fig. 3. Prognostic information from ECG patterns. (A and B) From patients without distortion of terminal position of the QRS complex. (C and D) From patients with terminal QRS distortion (emergence of J point at >50% of R-wave in leads with qR configuration or disappearance of S-wave in leads with Rs configuration). Reproduced with permission from ref. 40. (E) From a patient with anterior infarction with additional STE 15 min after initiation of thrombolysis with final resolution suggestive of favorable clinical outcome. Reproduced with permission from ref. 47.

patients with STEMI and a positive cardiac troponin T (cTnT) on admission vs 4.7% among those with negative cTnT results. This was confirmed by Giannitsis et al. (36), who reported a 9-mo mortality of 14 vs 3.9% among patients with STEMI and admission cTnT >0.1 ng/mL vs <0.1 mg/mL. Incomplete reperfusion was more common in patients with increased cTnT. In the Fragmin During Instability in Coronary Artery Disease (FRISC) study and other studies of patients with an acute coronary syndrome (36-38), cTnT >0.1 ng/mL predicts a lower likelihood of achieving TIMI III grade flow in the infarct related vessel with thrombolytic therapy or primary PCI.

Increased mortality rates among STEMI patients with elevated admission cTnT may be due to later presentation after symptom onset, microvascular dysfunction, or failure to achieve post procedural TIMI III flow. Higher rates of congestive heart failure and shock are also associated with elevated levels of cardiac troponin (39).

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