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| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions | |
| pubmed:issue |
6
|
| pubmed:dateCreated |
1998-10-20
|
| pubmed:abstractText |
Management of unstable angina is largely determined by symptoms, yet some symptomatic patients stabilize, whereas others develop myocardial infarction after waning of symptoms. Therefore, markers of short-term risk, available on admission, are needed. The value of 4 prognostic indicators available on admission (pain in the last 24 hours, electrocardiogram [ECG], troponin T, and C-reactive protein [CRP]), and of Holter monitoring available during the subsequent 24 hours was analyzed in 102 patients with Braunwald class IIIB unstable angina hospitalized in 4 centers. The patients were divided into 3 groups: group 1, 27 with pain during the last 24 hours and ischemic electrocardiographic changes; group 2, 45 with pain or electrocardiographic changes; group 3, 30 with neither pain nor electrocardiographic changes. Troponin T, CRP, ECG on admission, and Holter monitoring were analyzed blindly in the core laboratory. Fifteen patients developed myocardial infarction: 22% in group 1, 13% in group 2, and 10% in group 3. Twenty-eight patients underwent revascularization: 37% in group 1, 35% in group 2, and 7% in group 2 (p <0.01 between groups 1 or 2 vs group 3). Myocardial infarction was more frequent in patients with elevated troponin T (50% vs 9%, p=0.001) and elevated CRP (24% vs 4%, p= 0.01). Positive troponin T or CRP identified all myocardial infarctions in group 3. Only 1 of 46 patients with negative troponin T and CRP developed myocardial infarction. Among the indicators available on admission, multivariate analysis showed that troponin T (p=0.02) and CRP (p=0.04) were independently associated with myocardial infarction. Troponin T had the highest specificity (92%), and CRP the highest sensitivity (87%). Positive results on Holter monitoring were also associated with myocardial infarction (p=0.003), but when added to troponin T and CRP, increased specificity and positive predictive value by only 3%. Thus, in patients with class IIIB unstable angina, among data potentially available on admission, serum levels of troponin T and CRP have a significantly greater prognostic accuracy than symptoms and ECGs. Holter monitoring, available 24 hours later, adds no significant information.
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| pubmed:language |
eng
|
| pubmed:journal | |
| pubmed:citationSubset |
AIM
|
| pubmed:chemical | |
| pubmed:status |
MEDLINE
|
| pubmed:month |
Sep
|
| pubmed:issn |
0002-9149
|
| pubmed:author | |
| pubmed:issnType |
Print
|
| pubmed:day |
15
|
| pubmed:volume |
82
|
| pubmed:owner |
NLM
|
| pubmed:authorsComplete |
Y
|
| pubmed:pagination |
715-9
|
| pubmed:dateRevised |
2006-11-15
|
| pubmed:meshHeading |
pubmed-meshheading:9761079-Adult,
pubmed-meshheading:9761079-Aged,
pubmed-meshheading:9761079-Angina, Unstable,
pubmed-meshheading:9761079-Biological Markers,
pubmed-meshheading:9761079-C-Reactive Protein,
pubmed-meshheading:9761079-Coronary Angiography,
pubmed-meshheading:9761079-Electrocardiography, Ambulatory,
pubmed-meshheading:9761079-Female,
pubmed-meshheading:9761079-Follow-Up Studies,
pubmed-meshheading:9761079-Humans,
pubmed-meshheading:9761079-Male,
pubmed-meshheading:9761079-Middle Aged,
pubmed-meshheading:9761079-Myocardial Infarction,
pubmed-meshheading:9761079-Patient Admission,
pubmed-meshheading:9761079-Prognosis,
pubmed-meshheading:9761079-Reproducibility of Results,
pubmed-meshheading:9761079-Sensitivity and Specificity,
pubmed-meshheading:9761079-Troponin,
pubmed-meshheading:9761079-Troponin T
|
| pubmed:year |
1998
|
| pubmed:articleTitle |
Incremental prognostic value of serum levels of troponin T and C-reactive protein on admission in patients with unstable angina pectoris.
|
| pubmed:affiliation |
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
|
| pubmed:publicationType |
Journal Article,
Comparative Study,
Research Support, Non-U.S. Gov't,
Multicenter Study
|