TY - JOUR
T1 - Use of guidelines-recommended management and outcomes among women and men with low-level
T2 - Troponin elevation insights from crusade
AU - Halim, Sharif A.
AU - Mulgund, Jyotsna
AU - Chen, Anita Y.
AU - Roe, Matthew T.
AU - Peterson, Eric D.
AU - Gibler, W. Brian
AU - Ohman, E. Magnus
AU - Newby, L. Kristin
PY - 2009/5
Y1 - 2009/5
N2 - Background-Troponin elevation above the upper limit of normal (ULN) is diagnostic of myocardial infarction, but interpretation of "gray-zone" troponin elevations (1 to 1.5× ULN) remains uncertain. Using the CRUSADE database, we explored relationships between sex and treatment and outcomes among patients with troponin 1 to 1.5× ULN. Methods and Results-We compared treatment and outcomes among women and men using logistic generalized estimating equation method. Overall, 5049 of 85 671 (5.9%) non-ST-segment elevation acute coronary syndromes patients (2156 women, 2893 men) had troponin 1 to 1.5× ULN within 24 hours of presentation. Compared with troponin >1.5× ULN, "gray-zone" patients less often received all guidelines-indicated acute (mean composite score, 63% versus 72%) and discharge therapies (mean composite score, 73% versus 78%), but received them more frequently than patients with troponin <1× ULN (mean composite scores, 58% acute and 67% discharge). Among "gray-zone" patients, acute and discharge therapy use was similar between women and men, except acute aspirin (adjusted odds ratio, 0.80 [95% CI, 0.65 to 0.98]) and discharge angiotensin-converting enzyme inhibitors (adjusted odds ratio, 0.77 [95% CI, 0.67 to 0.88]). "Gray-zone" patients had lower mortality (2.3%) than the >1.5× ULN (4.5%) group but higher than the <1× ULN group (1.1%). Outcomes were similar among "gray-zone" women and men (adjusted odds ratios: death, 0.88 [95% CI, 0.58 to 1.35]; death/myocardial infarction, 0.77 [95% CI, 0.55 to 1.06]; transfusion, 1.04 [95% CI, 0.85 to 1.27]). Conclusions-Patients with non-ST-segment elevation acute coronary syndromes and low-level troponin elevations had lower overall risk and received less aggressive guidelines-based treatment than those with greater troponin elevations, but treatment patterns were largely similar by sex across troponin elevation groups. (Circ Cardiovasc Qual Outcomes. 2009;2:199-206.)
AB - Background-Troponin elevation above the upper limit of normal (ULN) is diagnostic of myocardial infarction, but interpretation of "gray-zone" troponin elevations (1 to 1.5× ULN) remains uncertain. Using the CRUSADE database, we explored relationships between sex and treatment and outcomes among patients with troponin 1 to 1.5× ULN. Methods and Results-We compared treatment and outcomes among women and men using logistic generalized estimating equation method. Overall, 5049 of 85 671 (5.9%) non-ST-segment elevation acute coronary syndromes patients (2156 women, 2893 men) had troponin 1 to 1.5× ULN within 24 hours of presentation. Compared with troponin >1.5× ULN, "gray-zone" patients less often received all guidelines-indicated acute (mean composite score, 63% versus 72%) and discharge therapies (mean composite score, 73% versus 78%), but received them more frequently than patients with troponin <1× ULN (mean composite scores, 58% acute and 67% discharge). Among "gray-zone" patients, acute and discharge therapy use was similar between women and men, except acute aspirin (adjusted odds ratio, 0.80 [95% CI, 0.65 to 0.98]) and discharge angiotensin-converting enzyme inhibitors (adjusted odds ratio, 0.77 [95% CI, 0.67 to 0.88]). "Gray-zone" patients had lower mortality (2.3%) than the >1.5× ULN (4.5%) group but higher than the <1× ULN group (1.1%). Outcomes were similar among "gray-zone" women and men (adjusted odds ratios: death, 0.88 [95% CI, 0.58 to 1.35]; death/myocardial infarction, 0.77 [95% CI, 0.55 to 1.06]; transfusion, 1.04 [95% CI, 0.85 to 1.27]). Conclusions-Patients with non-ST-segment elevation acute coronary syndromes and low-level troponin elevations had lower overall risk and received less aggressive guidelines-based treatment than those with greater troponin elevations, but treatment patterns were largely similar by sex across troponin elevation groups. (Circ Cardiovasc Qual Outcomes. 2009;2:199-206.)
KW - Acute coronary syndrome
KW - Outcomes
KW - Troponin
UR - http://www.scopus.com/inward/record.url?scp=77949898038&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77949898038&partnerID=8YFLogxK
U2 - 10.1161/CIRCOUTCOMES.108.810127
DO - 10.1161/CIRCOUTCOMES.108.810127
M3 - Article
C2 - 20031838
AN - SCOPUS:77949898038
SN - 1941-7713
VL - 2
SP - 199
EP - 206
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 3
ER -