Risk stratification with a point-of-care cardiac troponin T test in acute myocardial infarction. GUSTOIII Investigators. Global Use of Strategies To Open Occluded Coronary Arteries

Am J Cardiol. 1999 Dec 1;84(11):1281-6. doi: 10.1016/s0002-9149(99)00558-5.


Troponin T has been used successfully to risk stratify patients with acute coronary syndromes, but the utility of this approach using a rapid bedside assay in patients undergoing thrombolysis for ST-segment elevation acute myocardial infarction has not been assessed in a large population. We assessed whether a point-of-care, qualitative troponin T test at enrollment could independently risk-stratify patients randomized to receive alteplase or reteplase in the GUSTO-III trial. Complete troponin T data were available for 12,666 patients (84%) enrolled at 550 hospitals. The primary end point was mortality at 30 days, and the predictive ability of an elevated baseline troponin T level was analyzed (after adjustment for baseline characteristics) with multiple logistic regression. Patients with an elevated troponin T result at enrollment (8.9%) had significantly higher mortality at 30 days (unadjusted 15.7% vs 6.2% for negative patients; p = 0.001), which persisted even after adjustment for age, heart rate, location of infarction, Killip class, and systolic blood pressure. In a multivariable regression model, a positive troponin T result added independently to the prediction of 30-day mortality (chi-square 46, p = 0.001). A positive result with qualitative troponin T testing on admission is an independent marker of higher 30-day mortality. Troponin T testing could be a valuable addition to the evaluation strategy for patients with acute myocardial infarction.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aspirin / therapeutic use
  • Biomarkers / blood
  • Cause of Death
  • Drug Therapy, Combination
  • Electrocardiography*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Heparin / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / mortality
  • Point-of-Care Systems*
  • Prognosis
  • Prospective Studies
  • Recombinant Proteins / therapeutic use
  • Risk Assessment
  • Risk Factors
  • Survival Rate
  • Thrombolytic Therapy
  • Tissue Plasminogen Activator / therapeutic use
  • Troponin T / blood*
  • United States / epidemiology


  • Biomarkers
  • Fibrinolytic Agents
  • Recombinant Proteins
  • Troponin T
  • Heparin
  • reteplase
  • Tissue Plasminogen Activator
  • Aspirin