Non‐ST‐segment elevation ACS: does choice of antiplatelet therapy affect outcomes across troponin categories?

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  • Linear relationship was observed between increasing peak troponin and 30-mo ischaemic events in patients with non‐ST‐segment elevation acute coronary syndromes (NSTEACS).
  • Prasugrel vs clopidogrel showed no significant benefit in outcomes according to peak troponin.

Why this matters

  • Relationship between levels of troponin and outcomes among patients with NSTEMI is well-established; this is not explored in medically managed patients.
  • Study evaluated the effects of prasugrel and clopidogrel on outcomes according to troponin status.

Study design

  • 6763 medically managed patients with NSTEACS were randomly assigned to prasugrel or clopidogrel.
  • Relationship between peak troponin/upper limit of normal (ULN) ratio within 48 h of the index ACS event and 30‐mo outcomes were assessed.
  • Funding: Daiichi Sankyo Incorporated; Eli Lilly and Company.

Key results

  • Statistically significant differences in 30‐mo event rates were observed between peak troponin categories (<1×ULN, 6.2%; 1 to <3×ULN, 9.6%; 3 to <5×ULN, 10.8%; ≥5×ULN, 12.8%; P for all<.05).
  • No significant interactions were observed between peak troponin ratio and study treatment for any of the ischaemic outcomes after adjustment for confounding factors (P for all outcomes>.05).


  • Troponin assays were not standardized.
  • Post-hoc analysis.