Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin t-positive status:
L K Newby1, E M Ohman, R H Christenson
1Duke Clinical Research Institute, Durham, NC, USA. newby001@mc.duke.edu
Circulation
|June 20, 2001
Summary
Troponin T (TnT) levels help identify acute coronary syndrome (ACS) patients at high risk. Lamifiban treatment significantly benefited TnT-positive ACS patients, reducing adverse outcomes.
Area of Science:
- Cardiology
- Clinical Trials
- Biomarkers
Background:
- Troponin T (TnT) is a key biomarker for risk stratification in acute coronary syndromes (ACS).
- TnT levels may indicate which ACS patients benefit from glycoprotein (GP) IIb/IIIa inhibitors.
Purpose of the Study:
- To evaluate the predictive value of Troponin T (TnT) in non-ST-segment elevation ACS.
- To determine if lamifiban, an intravenous GP IIb/IIIa antagonist, offers therapeutic benefit in TnT-positive ACS patients.
Main Methods:
- Prospective study of 1160 patients with non-ST-segment elevation ACS randomized to lamifiban or placebo.
- Troponin T (TnT) levels measured at baseline and 24-72 hours; assays performed by a blinded core laboratory.
- Primary endpoint: composite of death, myocardial [re]infarction, or severe recurrent ischemia at 30 days.
Main Results:
- 40.2% of patients were TnT-positive at baseline; these patients had higher baseline risk.
- TnT-positive patients had a significantly higher rate of the primary endpoint (OR, 1.5; 95% CI, 1.1 to 2.1).
- Lamifiban significantly reduced the primary endpoint in TnT-positive patients (19.4% to 11.0%, P=0.01), but not in TnT-negative patients (P=0.86).
Conclusions:
- Troponin T (TnT) effectively predicts poor short-term outcomes in non-ST-segment elevation ACS.
- Treatment benefit of lamifiban was primarily observed in TnT-positive patients.
- Lamifiban reduced 30-day adverse outcomes in TnT-positive patients to levels similar to those in TnT-negative patients.
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