Troponin Levels Identify CAD Patients Likely to Benefit from Tirofiban: Results from the PRISM-Troponin Study, A substudy of the Platelet Receptor Inhibition in Ischemic Syndrome Management Study - PRISM-Troponin
The goal of the substudy was to assess the efficacy of early troponin measurements as a criterion for selecting patients most likely to respond to glycoprotein IIb/IIIa inhibitor therapy.
To assess the efficacy of early troponin measurements as a criterion for selecting patients most likely to respond to glycoprotein IIb/IIIa inhibitor therapy.
Patients Enrolled: 2240
Patients with CAD enrolled in the PRISM trial with chest pain in the preceding 24 hours.
Death, MI, or recurrent ischemia after 48 hour infusion and at 7 days and 30 days
Baseline levels of troponin I and troponin T were measured. All patients treated with aspirin and randomly assigned to treatment with tirofiban or heparin.
Approximately 70% of patients at normal levels of troponin at baseline; in these patients, the efficacy of tirofiban was equivalent to heparin. Approximately 29% of patients at elevated levels of troponin at baseline; in these patients, the combined endpoint of death plus MI at 30 days was 2.5% in the tirofiban group versus 17% in the heparin group. In addition, the need for revascularization was also doubled in the heparin group.
The data from this substudy indicate that troponin I and troponin T are reliable markers of elevated risk in patients with acute coronary syndromes and could be used to identify patients who are likely to benefit from treatment with tirofiban.
Writer's Note: This is an important substudy of PRISM. Troponin values are easily and quickly measured and seem to identify patients whose risk/benefit ratio is altered by the presence of a (+) troponin.
Lancet. 1999 Nov 20;354(9192):1757-62. ESC 1999, Clinical Trials, presented by CW Hamm, Bad Nauheim, Germany
Keywords: Acute Coronary Syndrome, Platelet Aggregation Inhibitors, Troponin I, Heparin, Troponin T, Fibrinolytic Agents, Tyrosine, Platelet Glycoprotein GPIIb-IIIa Complex
< Back to Listings