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Prediction of Recurrent Events by D-Dimer and Inflammatory Markers in Patients with Normal Cardiac Troponin I (PREDICT) Study.
Am Heart J. 2003 Jun; 145(6):986-92.AH

Abstract

BACKGROUND

The independent predictive value of d-dimer and inflammatory markers for the risk of recurrent adverse events in patients with acute chest pain but normal levels of cardiac troponin I (cTnI) remains unclear.

METHODS

We studied 391 patients admitted to the hospital in 1 year with acute ischemic-type chest pain. Creatine kinase-myocardial band isoenzyme (CK-MB) mass and cTnI levels were measured in initial and 12-hour samples. Soluble intercellular adhesion molecule (sICAM)-1, vascular cell adhesion molecule (sVCAM)-1, sP-selectin, sE-selectin, high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL6), fibrinogen, and d-dimer levels were measured in initial samples. A 1-year incidence of death, myocardial infarction (MI), revascularization, or readmission with chest pain was determined (with death/MI as the primary end point).

RESULTS

Patients with normal levels of CK-MB(mass) and cTnI (195/391[50%]) were at a lower risk than patients with elevated levels of CK-MB(mass) or cTnI, but still had an important incidence of events (77/195[39%]). Marker elevation was defined as >75th percentile (upper quartile). Elevated d-dimer levels (>580 ng/mL) was predictive of death/MI (odds ratio, 5.4; 95% CI, 1.5-20.2; P =.005). Elevated sP-selectin levels (>152 ng/mL; odds ratio, 3.2; 95% CI, 0.9-11.6; P =.06) trended to increased death/MI rates, with weaker trends for elevated levels of hsCRP (>7.1 mg/L), IL6 (>10.7 pg/mL), and ST depression. Other markers, other electrocardiogram changes, or classic risk factors were not predictive of death/MI. With a multivariate analysis, d-dimer and sP-selectin were found to be of independent significance for death/MI after adjustment for inflammatory, hemostatic, and electrocardiogram markers and d-dimer after adjustment for classic risk factors.

CONCLUSION

Normal cTnI levels after acute chest pain does not confer absence of future risk. Concurrent assessment of d-dimer and inflammatory markers may improve risk stratification.

Authors+Show Affiliations

Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland, UK. ian@imenown.freeserve.co.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12796753

Citation

Menown, Ian B A., et al. "Prediction of Recurrent Events By D-Dimer and Inflammatory Markers in Patients With Normal Cardiac Troponin I (PREDICT) Study." American Heart Journal, vol. 145, no. 6, 2003, pp. 986-92.
Menown IB, Mathew TP, Gracey HM, et al. Prediction of Recurrent Events by D-Dimer and Inflammatory Markers in Patients with Normal Cardiac Troponin I (PREDICT) Study. Am Heart J. 2003;145(6):986-92.
Menown, I. B., Mathew, T. P., Gracey, H. M., Nesbitt, G. S., Murray, P., Young, I. S., & Adgey, A. A. (2003). Prediction of Recurrent Events by D-Dimer and Inflammatory Markers in Patients with Normal Cardiac Troponin I (PREDICT) Study. American Heart Journal, 145(6), 986-92.
Menown IB, et al. Prediction of Recurrent Events By D-Dimer and Inflammatory Markers in Patients With Normal Cardiac Troponin I (PREDICT) Study. Am Heart J. 2003;145(6):986-92. PubMed PMID: 12796753.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of Recurrent Events by D-Dimer and Inflammatory Markers in Patients with Normal Cardiac Troponin I (PREDICT) Study. AU - Menown,Ian B A, AU - Mathew,Thomas P, AU - Gracey,Helen M, AU - Nesbitt,G Selby, AU - Murray,Pamela, AU - Young,Ian S, AU - Adgey,A A Jennifer, AU - ,, PY - 2003/6/11/pubmed PY - 2003/6/17/medline PY - 2003/6/11/entrez SP - 986 EP - 92 JF - American heart journal JO - Am Heart J VL - 145 IS - 6 N2 - BACKGROUND: The independent predictive value of d-dimer and inflammatory markers for the risk of recurrent adverse events in patients with acute chest pain but normal levels of cardiac troponin I (cTnI) remains unclear. METHODS: We studied 391 patients admitted to the hospital in 1 year with acute ischemic-type chest pain. Creatine kinase-myocardial band isoenzyme (CK-MB) mass and cTnI levels were measured in initial and 12-hour samples. Soluble intercellular adhesion molecule (sICAM)-1, vascular cell adhesion molecule (sVCAM)-1, sP-selectin, sE-selectin, high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL6), fibrinogen, and d-dimer levels were measured in initial samples. A 1-year incidence of death, myocardial infarction (MI), revascularization, or readmission with chest pain was determined (with death/MI as the primary end point). RESULTS: Patients with normal levels of CK-MB(mass) and cTnI (195/391[50%]) were at a lower risk than patients with elevated levels of CK-MB(mass) or cTnI, but still had an important incidence of events (77/195[39%]). Marker elevation was defined as >75th percentile (upper quartile). Elevated d-dimer levels (>580 ng/mL) was predictive of death/MI (odds ratio, 5.4; 95% CI, 1.5-20.2; P =.005). Elevated sP-selectin levels (>152 ng/mL; odds ratio, 3.2; 95% CI, 0.9-11.6; P =.06) trended to increased death/MI rates, with weaker trends for elevated levels of hsCRP (>7.1 mg/L), IL6 (>10.7 pg/mL), and ST depression. Other markers, other electrocardiogram changes, or classic risk factors were not predictive of death/MI. With a multivariate analysis, d-dimer and sP-selectin were found to be of independent significance for death/MI after adjustment for inflammatory, hemostatic, and electrocardiogram markers and d-dimer after adjustment for classic risk factors. CONCLUSION: Normal cTnI levels after acute chest pain does not confer absence of future risk. Concurrent assessment of d-dimer and inflammatory markers may improve risk stratification. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/12796753/Prediction_of_Recurrent_Events_by_D_Dimer_and_Inflammatory_Markers_in_Patients_with_Normal_Cardiac_Troponin_I__PREDICT__Study_ DB - PRIME DP - Unbound Medicine ER -