Re: Re: Re: Re: Request for Peter Flegg and Outstanding 'Perth Group' Questions 24 November 2004
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Tony Floyd,
Medical Student
Newcastle University,
Louis Feinberg, Joseph Wardell, Moses Horwitz and Jennifer Hawkins

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Re: Re: Re: Re: Re: Request for Peter Flegg and Outstanding 'Perth Group' Questions

As Peter Flegg rightly points out the fact that some countries might use troponin T and others might use troponin I to assist in diagnosing a heart attack hardly means that the orthodoxy have got it all wrong.

Troponins have only been used for less than a decade, so I imagine that there are many people having heart attacks in countries not using the latest tests. Yet dying all the same.

Dr Flegg might also find of interest some parallels between both HIV levels, troponin levels and death. The following is adapted from (1):

Plasma HIV RNA concentration
(copies/ml of blood)
Proportion of patients
developing AIDS within 6 years
<500
501 - 3,000
3,001 - 10,000
10,001 - 30,000
>30,000
5.4%
16.6%
31.7%
55.2%
80.0%

The authors concluded that:

"Plasma viral load strongly predicts the rate of decrease in CD4+ lymphocyte count and progression to AIDS and death"

Increasing levels of troponin also paints a bleak picture for a patient having and AMI:

Troponin T quartile
30 day mortality
1
2
3
4
1.1%
3.7%
3.7%
7.4%

With the authors (2) concluding:

"baseline levels of TnT ... are independently related to 30-day mortality"

***

References:

(1) Mellors JW, Munoz A, Giorgi JV, Margolick JB, Tassoni CJ, Gupta P, Kingsley LA, Todd JA, Saah AJ, Detels R, Phair JP, Rinaldo CR Jr. Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection. Ann Intern Med. 1997 Jun 15;126(12):946-54.

(2) James SK, Armstrong P, Barnathan E, Califf R, Lindahl B, Siegbahn A, Simoons ML, Topol EJ, Venge P, Wallentin L; GUSTO-IV-ACS Investigators. Troponin and C-reactive protein have different relations to subsequent mortality and myocardial infarction after acute coronary syndrome: a GUSTO-IV substudy. J Am Coll Cardiol. 2003 Mar 19;41(6):916-24.

Competing interests: None declared