737–5 Risk Stratification in Acute Ischemic Syndromes Using Serum Tropenin T

To evaluate whether serum Troponin T (Trop-T) or CK-MB analysis could be used to risk stratify patients with acute ischemic syndromes, admission serum samples were obtained in 865 patients enrolled in the GUSTO-lia study. Pts were stratified on admission into ST elevation (n=531) and non-ST elevation (n=334) groups. CK-MB (mass assay) and Trop-T (immunoassay) were measured by an enzymatic core laboratory. The median (25th, 75th parcentile) serum CK-MB was 2.9 (0.9, 8.2) ng/ml in the non-ST and 4.0 (1.5, 14.1) ng/ml in the ST elevation group. Corresponding Trop-T levels were 0.05 (0.01, 0.27) ng/ml and 0.04 (0.01, 0.33) ng/ml, respectively. Elevated levels of CK-MB (>7 ng/mll were seen in 33% and Trop-T levels >0.1 ng/ml were seen in 36% pts. Regression analysis documented that Trop-T levels were strongly associated with mortality (p<0.0001), while CK-M B levels were less strongly associated (p=0.03). In a regression model of both serum markers and mortality, CK-MB added no information (p=0.9) after the Trop-T levels were included. Higher admission Trop-T levels were also associated (p=0.005) with a poor clinical outcome using a composite endpoint of death, late (>18 hours after admission) myocardial infarction/reinfarction (MI), cardiogenic shock or heart failure (CHF), while only a weak relationship was observed with CK-MB (p=0.07). Outcomes based on admission Trop-T levels >0.1 ng/ml (Pos) or<0.1 (Neg) were as shown:Non-ST GroupST elevation GroupTrop-T NegTrop-T PasTrop-T NegTrop-T PasOutcomesN=201N=123N=324N=176Death1%9%5%12%Shock2%6%3%9%MI6%11%5%7%CHF7%16%10%15%In conclusion, Troponin T measurements in patients with acute ischemic syndromes can stratify patients into high and low risk categories. Early and rapid determination of Troponin T levels has the potential to streamline health care delivery in patients with acute ischemic syndromes