Troponin T and quantitative ST-segment depression offer complementary prognostic information in the risk
Padma Kaul1, L Kristin Newby, Yuling Fu
1Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
Insights
Quantitative ST-segment depression and cardiac troponin T elevation are complementary in assessing risk for acute coronary syndromes (ACS) patients. Both markers should be used for prognosis and medical decision-making.
Area of Science:
- Cardiology
- Biomarkers
- Electrocardiography
Background:
- The prognostic value of baseline electrocardiogram (ECG) and cardiac troponin T (cTnT) in acute coronary syndromes (ACS) requires comprehensive evaluation.
- Limited understanding exists regarding the combined utility of ST-segment depression (ST) and cTnT in risk stratification.
Purpose of the Study:
- To investigate the prognostic relationship between baseline ST-segment depression (ST) and cardiac troponin T (cTnT) elevation in ACS patients.
- To determine if ST provides additional prognostic insight beyond cTnT, particularly concerning glycoprotein IIb/IIIa therapy efficacy.
- To explore the impact of time to evaluation on the prognostic utility of both ST and cTnT.
Main Methods:
- Analysis of 959 patients from the PARAGON-B trial's cTnT substudy.
- Classification of patients based on ST-segment depression severity (none, 1 mm, ≥2 mm) and cTnT levels (≥0.1 ng/ml).
- Assessment of 6-month death/(re)myocardial infarction rates in relation to ST and cTnT status.
Main Results:
- Six-month adverse event rates ranged from 8.4% (cTnT-negative, no ST) to 26.8% (cTnT-positive, ST ≥2 mm).
- ST ≥2 mm on ECGs obtained >6 hours post-symptom onset showed higher risk (OR 7.3) compared to earlier ECGs (OR 2.1).
- Elevated cTnT within 6 hours of symptom onset indicated higher risk (OR 2.4) than elevations after 6 hours (OR 1.5).
Conclusions:
- Quantitative ST-segment depression and cTnT elevation are complementary prognostic markers in ACS.
- Both ST and cTnT should be utilized for comprehensive risk assessment and guiding medical decisions in ACS patients.
Objectives:
Our primary objective was to examine the prognostic relationship between baseline quantitative ST-segment depression (ST) and cardiac troponin T (cTnT) elevation. The secondary objectives were to: 1) examine whether ST provided additional insight into therapeutic efficacy of glycoprotein IIb/IIIa therapy similar to that demonstrated by cTnT; and 2) explore whether the time to evaluation impacted on each marker's relative prognostic utility.
Background:
The relationship between the baseline electrocardiogram (ECG) and cTnT measurements in risk-stratifying patients presenting with acute coronary syndromes (ACS) has not been evaluated comprehensively.
Methods:
The study population consisted of 959 patients enrolled in the cTnT substudy of the Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON)-B trial. Patients were classified as having no ST (n = 387), 1 mm ST (n = 433), and ST > or =2 mm (n = 139). Forty-percent (n = 381) were classified as cTnT-positive based on a definition of > or =0.1 ng/ml.
Results:
Six-month death/(re)myocardial infarction rates were 8.4% among cTnT-negative patients with no ST and 26.8% among cTnT-positive patients with ST > or =2 mm. On ECGs done after 6 h of symptom onset, ST > or =2 mm was associated with higher risk compared to its presence on ECGs done earlier (odds ratio [OR] 7.3 vs. 2.1). In contrast, the presence of elevated cTnT within 6 h of symptom was associated with a higher risk of adverse events compared with elevations after 6 h (OR 2.4 vs. 1.5).
Conclusions:
Quantitative ST and cTnT status are complementary in assessing risk among ACS patients and both should be employed to determine prognosis and assist in medical decision making.
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