1 / 10

Association of Troponin Elevation with Risk of Mortality in Acute Coronary Syndromes

%. %. %. Mortality at 42 Days. %. %. %. 831. 174. 148. 134. 50. 67. . Association of Troponin Elevation with Risk of Mortality in Acute Coronary Syndromes. Antman EM. N Engl J Med 1996; 335: 12342-1349. Audience Poll.

mortimer
Télécharger la présentation

Association of Troponin Elevation with Risk of Mortality in Acute Coronary Syndromes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. % % % Mortality at 42 Days % % % 831 174 148 134 50 67  Association of Troponin Elevation with Risk of Mortality in Acute Coronary Syndromes Antman EM. N Engl J Med 1996; 335: 12342-1349.

  2. Audience Poll • What is the most powerful predictor of the patient’s troponin status? Circulation 2002;106:202-207

  3. The Presence of A Stained or Closed Muscle on Diagnostic Cath Circulation 2002;106:202-207

  4. Troponin T & Angiographic Findings P=0.021 P=0.007 P=0.0003 P=0.03 % Normal TMPG 3 % Thrombus % Stenosis % Vessel Occlusion tnT - tnT + tnT - tnT + tnT - tnT + tnT - tnT + Even when epicardial TIMI flow grade and the presence of thrombus were adjusted for, the presence of a closed microvasculature was independently associated with tnT elevation in a multivariate model (O.R. 1.79, p=0.017). Circulation 2002;106:202-207

  5. Peak [tnT] and [tnI] by TIMI Myocardial Perfusion Grade (TMPG) status P=0.007 P=0.006 Tn I (ng / mL) tn T (ng / mL) TMPG 2/3 TMPG 0/1 TMPG 0/1 TMPG 2/3 Circulation 2002;106:202-207

  6. Troponin Elevations on Admission are Associated with Tissue Level Perfusion Following PCI: TACTICS TIMI 18 p=0.004 p=0.013 % TMPG 0/1 % TMPG 0/1 Circulation 2002;106:202-207

  7. Event Free Survival is Associated with Tissue Level Perfusion in UA / Non Q Wave MI: TACTICS – TIMI 18 P = 0.018 % TMPG 3 TMPG 2/3 Pre or Post-PCI Slow Normal N = 253 N = 253 p=0.026 “Upstream” Duration (> median) TMPG 0/1 Pre & Post PCI Event Free Survival Gibson. Am J Cardiol. 2004; 94:492-4 Stain Pale • Impaired tissue perfusion on diagnostic cath is associated with Tn + and adverse outcomes • Earlier upstream initiation of GPIIbIIIa inhibition is associated with improved tisse perfusion om diagnostic cath Days Circulation 2002;106:202-207

  8. 100 100 80 80 60 60 40 40 20 20 0 0 Thrombus Is Less Common and Flow Is Better With Upstream GP IIb/IIIa Use Overall Odds Ratio: 0.77 P=0.022 Fresh occlusion TIMI Flow Medium or large thrombus Grade 3 Grade 2 % Patients Possible or small thrombus Grade 1 Grade 0 No thrombus Heparin Alone Tirofiban + Heparin Heparin Alone Tirofiban + Heparin Zhao et al. Circulation. 1999;100:1609-1615.

  9. 30 30 25 25 20 20 15 15 10 10 5 5 0 0 Long-Term Benefit of Upstream Therapy in Reducing Thrombus and Improving TIMI 3 Flow Events at 30 Days Thrombus TIMI 0-2 (n=298) No thrombus TIMI 3 (n=1095) 20% Patients With Event (%) 12% 10% 9% 7.4% 5.5% Composite MI/Death Refract Isch Composite MI/Death Refract Isch Hazard ratio P value 1.72 <0.001 1.44 0.08 1.68 0.02 1.72 <0.001 1.44 0.08 1.68 0.02 Zhao et al. Circulation. 1999;100:1609-1615.

  10. 5.3 % * NRMI also shows that early GP IIb-IIIa inhibitor therapy reduces in-hospital mortality P < 0.001n = 32,710 8.5 % In-hospital Death 3.2 % GP IIb-IIIa Inhibitor < 24 Hrs. GP IIb-IIIa Inhibitor > 24 Hrs. * Unadjusted for risk. Peterson E. Presented at ACC. March 2002.

More Related