{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:51:02Z","timestamp":1781765462412,"version":"3.54.5"},"reference-count":17,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2006,12,5]],"date-time":"2006-12-05T00:00:00Z","timestamp":1165276800000},"content-version":"vor","delay-in-days":764,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2004,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Background:<\/jats:italic> Classification of patients with unstable angina (UA) by Agency for Health Care Policy and Research (AHCPR) guidelines in the emergency department reliably stratifies risk of death or myocardial infarction (MI) for triage to outpatient evaluation (low\u2010risk), hospitalization (high\u2010risk), or additional testing (intermediate\u2010risk). Cardiac troponin\u2010I elevation may identify patients at higher risk, but the incremental value may vary with AHCPR clinical risk.<\/jats:p><jats:p><jats:italic>Hypothesis:<\/jats:italic> The objective of this study was to determine whether cardiac troponin\u2010I had any additional value beyond triage based upon history, physical examination, and electrocardiogram, in the evaluation of patients with UA.<\/jats:p><jats:p><jats:italic>Methods:<\/jats:italic> In all, 212 consecutive patients with UA and normal serum creatine kinase (CK)\u2010MB levels and elevated troponin\u2010I were risk stratified by AHCPR guidelines to evaluate the incremental value of adding routine troponin\u2010I measurements to our current model for risk stratification.<\/jats:p><jats:p><jats:italic>Results:<\/jats:italic> Primary events (death\/nonfatal MI) occurred in 35% of high\u2010risk, 15% of intermediate\u2010risk, and 0% of low\u2010risk patients (p &lt; 0.001 by chisquare for trend). High troponin\u2010I (\u2265 2.0 ng\/dl) occurred in 48% of high\u2010risk, 21% of intermediate\u2010risk, and 19% of low\u2010risk patients. The remaining patients in each risk group had indeterminate troponin\u2010I levels (\u22650.4 &lt; 2 ng\/dl). Of those with high troponin\u2010I, a primary event occurred in 36, 42, and 0% in the respective high\u2010, intermediate\u2010, and low\u2010risk groups (p &lt; 0.001). High troponin\u2010I levels corresponded with a statistically significant increased rate of primary events only in patients at AHCPR intermediate risk: 42.4 vs. 7.3%, p &lt; 0.001.<\/jats:p><jats:p><jats:italic>Conclusion:<\/jats:italic> The AHCPR guidelines risk stratify patients with UA. High troponin\u2010I adds significant (p &lt; 0.001) prognostic value in the patients at AHCPR intermediate risk and should be evaluated further in larger trials of such patients.<\/jats:p>","DOI":"10.1002\/clc.4960271113","type":"journal-article","created":{"date-parts":[[2007,6,27]],"date-time":"2007-06-27T19:47:13Z","timestamp":1182973633000},"page":"646-651","source":"Crossref","is-referenced-by-count":2,"title":["The incremental value of troponin\u2010I testing in patients with intermediate risk unstable angina"],"prefix":"10.1002","volume":"27","author":[{"given":"Evan","family":"Appelbaum","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Urooj","family":"Zafar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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