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Titolo:
Markers of myocardial damage in acute coronary syndromes - therapeutic implications
Autore:
Lindahl, B;
Indirizzi:
Univ Hosp, Dept Cardiol, Uppsala Cardiothorac Ctr, Uppsala, Sweden Univ Hosp Uppsala Sweden iol, Uppsala Cardiothorac Ctr, Uppsala, Sweden
Titolo Testata:
CLINICA CHIMICA ACTA
fascicolo: 1, volume: 311, anno: 2001,
pagine: 27 - 32
SICI:
0009-8981(20010915)311:1<27:MOMDIA>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
CARDIAC TROPONIN-T; REFRACTORY UNSTABLE ANGINA; ARTERY DISEASE; INFARCTION; RISK; STRATIFICATION; METAANALYSIS; EFFICACY; PECTORIS; BENEFIT;
Keywords:
myocardial damage; troponins; antithrombotic therapies; cardiac markers; reperfusion treatment;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Lindahl, B Univ Hosp, Dept Cardiol, Uppsala Cardiothorac Ctr, Uppsala, Sweden Univ Hosp Uppsala Sweden a Cardiothorac Ctr, Uppsala, Sweden
Citazione:
B. Lindahl, "Markers of myocardial damage in acute coronary syndromes - therapeutic implications", CLIN CHIM A, 311(1), 2001, pp. 27-32

Abstract

Patients admitted with suspicion of an acute coronary syndrome (ACS) stillconstitute a diagnostic, prognostic and therapeutic challenge for the treating physician. The final diagnosis ranges from a noncardiac diagnosis to afull-blown myocardial infarction (MI). Biochemical markers of myocardial damage are essential for diagnosis and, especially troponin T and troponin I, have been shown to be valuable, for early risk stratification and for selection of treatment in ACS. Patients identified to be at low risk of future cardiac events might be discharged early, and unnecessary investigations and treatments avoided. On the contrary, a more intense treatment can be started in patients identifiedto be at high risk. Unstable angina patients with, compared to without, elevation of troponin, have a more activated coagulation system and more frequently complex lesions and visible thrombus in their coronary arteries. Accordingly, antithrombotic and antiplatelet therapies, i.e. l.m.w heparin andGP IIb/IIIa receptor antagonists, have been proved to have beneficial effects in troponin positive patients, but little or no beneficial effects in troponin negative patients. Also, the beneficial effects of an invasive compared to a noninvasive approach seem to be much more pronounced in troponin positive patients. In patients with ST-elevation MI, an elevated troponin T level at admission are associated with an increased mortality. However, the therapeutic implications of this finding remain speculative. Patients admitted with chest pain and left bundle branch block (LBBB) and who develop an MI have a poor prognosis. Current guidelines in acute myocardial infarction state that these patients should receive thrombolysis. Despite that, only a minority of these patients do receive thrombolysis, most probably because of the great diagnostic uncertainty. Rapid testing with a cardiac marker, e.g. myoglobin, would most probably increase the proportion of patients with chest pain and LBBB who receive appropriate reperfusion treatment. (C) 2001 Elsevier Science B.V. All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 08/07/20 alle ore 00:56:53