The diagnostic and prognostic impact of the redefinition of acute myocardial infarction: lessons from the Global Registry of Acute Coronary Events (GRACE)
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Authors
Goodman, Shaun G.Steg, Phillippe Gabriel
Eagle, Kim A.
Fox, Keith A. A.
Lopez-Sendon, Jose
Montalescot, Gilles
Budaj, Andrzej
Kennelly, Brian M.
Gore, Joel M.
Allegrone, Jeanna
Granger, Christopher B.
Gurfinkel, Enrique P.
GRACE Investigators
UMass Chan Affiliations
Department of Medicine, Division of Cardiovascular MedicineCenter for Outcomes Research
Document Type
Journal ArticlePublication Date
2006-03-01Keywords
AgedBiological Markers
Creatine Kinase
Creatine Kinase, MB Form
Female
Hospital Mortality
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction
Prognosis
Registries
Survival Analysis
Troponin
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: The impact and prognostic value of the redefinition of myocardial infarction (MI) with more sensitive markers have not been evaluated prospectively in a large, less selected population with acute coronary syndrome (ACS). METHODS: We evaluated the attack and case-fatality rates of MI based on initial and/or peak creatine kinase (CK), creatine kinase-MB (CK-MB), and cardiac troponin (the upper limit of normal [ULN] was defined according to the local hospital's standard) in a prospective observational registry of 26,267 patients with ACS admitted to 106 hospitals in 14 countries. RESULTS: The addition of cardiac troponin-positive status to CK status as a criterion for the diagnosis of MI resulted in as many as 1 in 4 additional patients meeting the redefined criteria. Compared with patients without elevated levels of CK and cardiac troponin, the crude odds for dying during hospitalization were significantly higher for patients with elevated troponin but not CK levels of greater than or equal to the ULN (odds ratio [OR] 2.2, 95% CI 1.6-2.9), those without CK levels >2 times the ULN (OR 2.8, 95% CI 2.2-3.5), and those with nonelevated levels of CK-MB (OR 2.1, 95% CI 1.4-3.2). The addition of cardiac troponin-positive status significantly increased the multivariable-adjusted odds for hospital death in patients with CK < or =2 times the ULN (OR 1.6, 95% CI 1.2-2.1) but not for patients without elevated levels of CK or CK-MB. CONCLUSIONS: The prognostic value of cardiac troponin, beyond that supplied by CK status or important baseline characteristics, assists in the identification of patients with ACS who are at increased risk for death.Source
Am Heart J. 2006 Mar;151(3):654-60. Link to article on publisher's siteDOI
10.1016/j.ahj.2005.05.014Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27239PubMed ID
16504627Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.ahj.2005.05.014