Troponin-positive, MB-negative patients with non–ST-elevation myocardial infarction: An undertreated but high-risk patient group: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines (NCDR ACTION-GWTG) Registry
Autor: | Anita Chen, JoAnne M. Foody, James A. de Lemos, Fang Shu Ou, Michael C. Kontos, L. Kristin Newby, Matthew T. Roe, Stephan D. Wiviott |
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Rok vydání: | 2010 |
Předmět: |
Male
medicine.medical_specialty Ticlopidine medicine.medical_treatment Myocardial Infarction Coronary Angiography Revascularization Antithrombins Coronary artery disease Electrocardiography Risk Factors Internal medicine Myocardial Revascularization medicine Creatine Kinase MB Form Humans Hospital Mortality Registries Myocardial infarction Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test biology business.industry ST elevation Middle Aged Prognosis medicine.disease Clopidogrel Troponin United States Heart failure Practice Guidelines as Topic biology.protein Cardiology Drug Therapy Combination Female Hydroxymethylglutaryl-CoA Reductase Inhibitors Cardiology and Cardiovascular Medicine business Biomarkers Platelet Aggregation Inhibitors Follow-Up Studies medicine.drug |
Zdroj: | American Heart Journal. 160:819-825 |
ISSN: | 0002-8703 |
Popis: | Despite the 2000 and 2007 redefinition of myocardial infarction (MI), patients who are troponin (Tn) positive ([+]) but MB negative ([-]) may not be considered to have MI, particularly in the absence of known coronary disease (prior MI or revascularization; coronary artery disease [CAD]). How this affects treatment and outcomes has not been well described.Direct arrival patients with non-ST elevation MI (NSTEMI) enrolled in the American College of Cardiology NCDR ACTION-GWTG Registry were included. Patients missing marker data who were Tn (-) and had CAD were excluded. Troponin (+) patients were categorized as MB (+) (n = 11,563) or MB (-) (n = 4,501). Treatments and in-hospital outcomes were compared between the 2 groups using logistic regression.Of the 16,064 NSTEMI patients, 28% were MB (-). The MB (-) patients were older (median age 68 vs 65 years) and had more comorbidities (hypertension 71% vs 66%, diabetes 31% vs 27%, heart failure 22% vs 19%; all Ps.01). After adjusting for baseline characteristics, MB (-) patients were significantly less likely to receive clopidogrel, antithrombins, glycoprotein IIb/IIIa antagonists, or angiography (all Ps.001). In-hospital mortality was lower in MB (-) patients (3.8% vs 4.9%, P.01), which remained significant after adjusting for baseline variables (odds ratio 0, 69, 95% CI 0.6-0.9, P = .002).Patients without known CAD who have NSTEMI and are MB (-) have a higher risk profile but are less likely to receive guideline-recommended acute pharmacologic treatment than those who are MB (+). Given the relatively high mortality in this group, increased emphasis on improving quality of care in Tn (+)/MB (-) patients is warranted. |
Databáze: | OpenAIRE |
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