Troponin-positive, MB-negative patients with non-ST-elevation myocardial infarction: An undertreated but high-risk patient group: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (NCDR ACTION-GWTG) Registry

Michael C. Kontos, James A de Lemos, Fang Shu Ou, Stephan D. Wiviott, Joanne M. Foody, L. Kristin Newby, Anita Chen, Matthew T. Roe

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Abstract

Background: Despite the 2000 and 2007 redefinition of myocardial infarction (MI), patients who are troponin (Tn) positive ([+]) but MB negative ([-]) may not be considered to have MI, particularly in the absence of known coronary disease (prior MI or revascularization; coronary artery disease [CAD]). How this affects treatment and outcomes has not been well described. Methods: Direct arrival patients with non-ST elevation MI (NSTEMI) enrolled in the American College of Cardiology NCDR ACTION-GWTG Registry were included. Patients missing marker data who were Tn (-) and had CAD were excluded. Troponin (+) patients were categorized as MB (+) (n = 11,563) or MB (-) (n = 4,501). Treatments and in-hospital outcomes were compared between the 2 groups using logistic regression. Results: Of the 16,064 NSTEMI patients, 28% were MB (-). The MB (-) patients were older (median age 68 vs 65 years) and had more comorbidities (hypertension 71% vs 66%, diabetes 31% vs 27%, heart failure 22% vs 19%; all Ps < .01). After adjusting for baseline characteristics, MB (-) patients were significantly less likely to receive clopidogrel, antithrombins, glycoprotein IIb/IIIa antagonists, or angiography (all Ps < .001). In-hospital mortality was lower in MB (-) patients (3.8% vs 4.9%, P < .01), which remained significant after adjusting for baseline variables (odds ratio 0, 69, 95% CI 0.6-0.9, P = .002). Conclusions: Patients without known CAD who have NSTEMI and are MB (-) have a higher risk profile but are less likely to receive guideline-recommended acute pharmacologic treatment than those who are MB (+). Given the relatively high mortality in this group, increased emphasis on improving quality of care in Tn (+)/MB (-) patients is warranted.

Original languageEnglish (US)
Pages (from-to)819-825
Number of pages7
JournalAmerican Heart Journal
Volume160
Issue number5
DOIs
StatePublished - Nov 2010

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Troponin
Registries
Guidelines
Coronary Artery Disease
clopidogrel
Myocardial Infarction
Non-ST Elevated Myocardial Infarction
Myocardial Revascularization
Platelet Glycoprotein GPIIb-IIIa Complex
Antithrombins
Quality of Health Care
Hospital Mortality
Coronary Disease
Comorbidity
Angiography
Heart Failure
Logistic Models
Odds Ratio
Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{d30d5ca578f34e279141c9da525faa91,
title = "Troponin-positive, MB-negative patients with non-ST-elevation myocardial infarction: An undertreated but high-risk patient group: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (NCDR ACTION-GWTG) Registry",
abstract = "Background: Despite the 2000 and 2007 redefinition of myocardial infarction (MI), patients who are troponin (Tn) positive ([+]) but MB negative ([-]) may not be considered to have MI, particularly in the absence of known coronary disease (prior MI or revascularization; coronary artery disease [CAD]). How this affects treatment and outcomes has not been well described. Methods: Direct arrival patients with non-ST elevation MI (NSTEMI) enrolled in the American College of Cardiology NCDR ACTION-GWTG Registry were included. Patients missing marker data who were Tn (-) and had CAD were excluded. Troponin (+) patients were categorized as MB (+) (n = 11,563) or MB (-) (n = 4,501). Treatments and in-hospital outcomes were compared between the 2 groups using logistic regression. Results: Of the 16,064 NSTEMI patients, 28{\%} were MB (-). The MB (-) patients were older (median age 68 vs 65 years) and had more comorbidities (hypertension 71{\%} vs 66{\%}, diabetes 31{\%} vs 27{\%}, heart failure 22{\%} vs 19{\%}; all Ps < .01). After adjusting for baseline characteristics, MB (-) patients were significantly less likely to receive clopidogrel, antithrombins, glycoprotein IIb/IIIa antagonists, or angiography (all Ps < .001). In-hospital mortality was lower in MB (-) patients (3.8{\%} vs 4.9{\%}, P < .01), which remained significant after adjusting for baseline variables (odds ratio 0, 69, 95{\%} CI 0.6-0.9, P = .002). Conclusions: Patients without known CAD who have NSTEMI and are MB (-) have a higher risk profile but are less likely to receive guideline-recommended acute pharmacologic treatment than those who are MB (+). Given the relatively high mortality in this group, increased emphasis on improving quality of care in Tn (+)/MB (-) patients is warranted.",
author = "Kontos, {Michael C.} and {de Lemos}, {James A} and Ou, {Fang Shu} and Wiviott, {Stephan D.} and Foody, {Joanne M.} and Newby, {L. Kristin} and Anita Chen and Roe, {Matthew T.}",
year = "2010",
month = "11",
doi = "10.1016/j.ahj.2010.07.022",
language = "English (US)",
volume = "160",
pages = "819--825",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "5",

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TY - JOUR

T1 - Troponin-positive, MB-negative patients with non-ST-elevation myocardial infarction

T2 - An undertreated but high-risk patient group: Results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (NCDR ACTION-GWTG) Registry

AU - Kontos, Michael C.

AU - de Lemos, James A

AU - Ou, Fang Shu

AU - Wiviott, Stephan D.

AU - Foody, Joanne M.

AU - Newby, L. Kristin

AU - Chen, Anita

AU - Roe, Matthew T.

PY - 2010/11

Y1 - 2010/11

N2 - Background: Despite the 2000 and 2007 redefinition of myocardial infarction (MI), patients who are troponin (Tn) positive ([+]) but MB negative ([-]) may not be considered to have MI, particularly in the absence of known coronary disease (prior MI or revascularization; coronary artery disease [CAD]). How this affects treatment and outcomes has not been well described. Methods: Direct arrival patients with non-ST elevation MI (NSTEMI) enrolled in the American College of Cardiology NCDR ACTION-GWTG Registry were included. Patients missing marker data who were Tn (-) and had CAD were excluded. Troponin (+) patients were categorized as MB (+) (n = 11,563) or MB (-) (n = 4,501). Treatments and in-hospital outcomes were compared between the 2 groups using logistic regression. Results: Of the 16,064 NSTEMI patients, 28% were MB (-). The MB (-) patients were older (median age 68 vs 65 years) and had more comorbidities (hypertension 71% vs 66%, diabetes 31% vs 27%, heart failure 22% vs 19%; all Ps < .01). After adjusting for baseline characteristics, MB (-) patients were significantly less likely to receive clopidogrel, antithrombins, glycoprotein IIb/IIIa antagonists, or angiography (all Ps < .001). In-hospital mortality was lower in MB (-) patients (3.8% vs 4.9%, P < .01), which remained significant after adjusting for baseline variables (odds ratio 0, 69, 95% CI 0.6-0.9, P = .002). Conclusions: Patients without known CAD who have NSTEMI and are MB (-) have a higher risk profile but are less likely to receive guideline-recommended acute pharmacologic treatment than those who are MB (+). Given the relatively high mortality in this group, increased emphasis on improving quality of care in Tn (+)/MB (-) patients is warranted.

AB - Background: Despite the 2000 and 2007 redefinition of myocardial infarction (MI), patients who are troponin (Tn) positive ([+]) but MB negative ([-]) may not be considered to have MI, particularly in the absence of known coronary disease (prior MI or revascularization; coronary artery disease [CAD]). How this affects treatment and outcomes has not been well described. Methods: Direct arrival patients with non-ST elevation MI (NSTEMI) enrolled in the American College of Cardiology NCDR ACTION-GWTG Registry were included. Patients missing marker data who were Tn (-) and had CAD were excluded. Troponin (+) patients were categorized as MB (+) (n = 11,563) or MB (-) (n = 4,501). Treatments and in-hospital outcomes were compared between the 2 groups using logistic regression. Results: Of the 16,064 NSTEMI patients, 28% were MB (-). The MB (-) patients were older (median age 68 vs 65 years) and had more comorbidities (hypertension 71% vs 66%, diabetes 31% vs 27%, heart failure 22% vs 19%; all Ps < .01). After adjusting for baseline characteristics, MB (-) patients were significantly less likely to receive clopidogrel, antithrombins, glycoprotein IIb/IIIa antagonists, or angiography (all Ps < .001). In-hospital mortality was lower in MB (-) patients (3.8% vs 4.9%, P < .01), which remained significant after adjusting for baseline variables (odds ratio 0, 69, 95% CI 0.6-0.9, P = .002). Conclusions: Patients without known CAD who have NSTEMI and are MB (-) have a higher risk profile but are less likely to receive guideline-recommended acute pharmacologic treatment than those who are MB (+). Given the relatively high mortality in this group, increased emphasis on improving quality of care in Tn (+)/MB (-) patients is warranted.

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U2 - 10.1016/j.ahj.2010.07.022

DO - 10.1016/j.ahj.2010.07.022

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JO - American Heart Journal

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SN - 0002-8703

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