Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban

• Published in: The Lancet (British edition) 1999-11, Vol.354 (9192), p.1757-1762
• Main Authors: Heeschen, Christopher, Hamm, Christian W, Goldmann, Britta, Deu, Ariane, Langenbrink, Lukas, White, Harvey D
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Drug therapy
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(99)10285-X

A major challenge for physicians is to identify patients with acute coronary syndromes who may benefit from treatment with glycoprotein-IIb/IIIa-receptor antagonists. We investigated whether troponin concentrations can be used to stratify patients for benefit from treatment with tirofiban. We enrolled 2222 patients of the Platelet Receptor Inhibition in Ischemic Syndrome Management study with coronary artery disease and who had had chest pain in the previous 24 h. All patients received aspirin and were randomly assigned treatment with tirofiban or heparin. We took baseline measurements of troponin I and troponin T. We recorded death, myocardial infarction, or recurrent ischaemia after 48 h infusion treatment and at 7 days and 30 days. 629 (28·3%) patients had troponin I concentrations higher than the diagnostic threshold of 1·0 μg/L and 644 (29·0%) troponin T concentrations higher than 0·1 μg/L. 30-day event rates (death, myocardial infarction) were 13·0% for troponin-I-positive patients compared with 4·9% for troponin-I-negative patients (p