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 - 05/08/11
, James A. de Lemos, MD b, Fang-Shu Ou, MS c, Stephan D. Wiviott, MD d, Joanne M. Foody, MD d, L. Kristin Newby, MD c, Anita Chen, MS c, Matthew T. Roe, MD, MHS cRiassunto |
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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Vol 160 - N° 5
P. 819-825 - Novembre 2010 Ritorno al numero
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