Copyright © 2004 by the European Society of Cardiology.
Clinical research
Troponin is more useful than creatine kinase in predicting one-year mortality among acute coronary syndrome patients
a Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Room 4-072 Queen, Toronto, Ont., Canada M5B 1W8
b Canadian Heart Research Centre, Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ont., Canada M5B 2P9
c St Joseph's Healthcare, McMaster University Avenue, Suite 300, Toronto, Ont., Canada M5G 2P9
Received May 13, 2004; revised July 30, 2004; accepted August 5, 2004 * Corresponding author. Tel.: +416 864 5722; fax: +416 864 5407 (E-mail: goodmans{at}smh.toronto.on.ca).
AIMS: To compare the long-term prognostic value of troponins (Tn) vs. conventional cardiac biomarker creatine kinase (CK) and CK-MB across the spectrum of acute coronary syndromes (ACS).
METHODS AND RESULTS: In the prospective, observational Canadian ACS Registry, 4627 patients with ACS were enrolled from 51 centres. The CK, CK-MB, Tn samples were analysed in each hospital clinical laboratory and the results related to the reference levels of the individual laboratories. The study cohort comprised 3138 (67.8%) patients who had both CK (or CK-MB) and Tn measurements during the first 24 h of hospitalisation. Vital status at one-year was determined by standardized telephone interview. 61.2% and 59.0% of patients had abnormal Tn and CK (or CK-MB) levels, respectively. Vital status at one-year was ascertained for 2950 patients (6% lost to follow-up). Among patients with normal CK (or CK-MB) levels, elevated Tn was associated with increased one-year mortality (odds ratio [OR] 2.06; 95% CI 1.37–3.11; P=0.001). Similarly, among patients with abnormal CK (or CK-MB) levels, abnormal Tn predicted higher one-year mortality (OR 1.83; 95% CI 1.14–2.93; P=0.01). In contrast, abnormal CK (or CK-MB) was not predictive of mortality after stratification by Tn status. In multivariable analysis controlling for other known prognosticators including creatinine, abnormal Tn (adjusted OR 1.78; 95% CI 1.30–2.44; P<0.001) but not CK/CK-MB was independently associated with increased one-year mortality.
CONCLUSIONS: Elevated Tn was independently associated with worse outcome at one-year, while CK or CK-MB status did not provide incremental prognostic information. Our findings support the use of Tn in the risk stratification of unselected ACS patients.
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