JACC March 6, 2002 agement in the TACTICS-TIM118 trial. Decision-limits of 80 pg/ml for SNP and 0.1 ng/ml for cTnl were pre-specified based on prior work. RESULTS: Pts with baseline BNP > 80 ng/ml (n = 310) were at significantly higher risk of death by 30 days (5,2 vs. 1.2%, p<0.00Of) and 6 months (8.7 vs. 1.7%, p<0.0O01) after presentation. BNP predicted mortality independently of age, ST-segment depression, cTnl result, history of CHF and Killip class at presentation (p<0.0001). Importantly, BNP identified patients with negative oTnl who were at high risk for death (p=0.004) and death/MI (p=0.008) [FIG]. There was no significant difference in the benefit of INV vs. CON therapy among pts with positive vs. negative BNP with respect to deatWMI at 30 and 180 days (p-interaction >0.5). CON- CLUSIONS: BNP adds complementary information to cardiac troponin for risk assess- ment in unstable angina/non-ST elevation MI. Future research should aim at interventions which may reduce the risk associated with increased BNP. 10 DEATH 8 6 4 2 0 C I nl Nr.S.# Ci nl 1"1~4~ BNP + + p : 0.004 <0.001 DEATH or MI C I nl NI:CJ ¢lnl I-U6 4* 4. 0.008 NS 822-5 3:00 p.m. The Inter-Relationship Between Creatinine Clearance, Cardiac Troponin T And Outcomes in Patients With Acute Coronary Syndromes Ronnier J. Aviles. Arman T. Askari, E. Magnus Ohman, Kenneth W. Mahaffy, L. Kristin Newby, Peter Berger, Gang Jia, Robert M. Califf, Bertil Lindahl, Lars Wallentin, Eric J. Topoi, Michael S. Lauer, Cleveland Clinic Foundation, Cleveland, Ohio. Background: Although abnormal cardiac troponin T (TnT) is predictive of poor outcome, the prognostic value of cardiac troponin T in patients with renal impairment remains contro- versial. Methods: In GUSTO IV, 7800 with ACS were randomized to treatment with placebo, abcix- imab for 24 hours, or abciximab for 48 hours. The study cohort comprised 7637 subjects with complete TnT, creatinine clearance (CCI), and clinical data. Baseline TnT and CCI were analyzed. CCI was evaluated as categorical and as a continuous variable. Abnormal TnT: TnT > 0.1 mg/dL; abnormal CCI: CCI < median CCI (76 ml/min.). End point: composite of 30-day death and MI. Results: Death/MI occurred in 648 subjects. There were 126 (6%) events in patients with abnormal TnT, 140 (8%) events in patients with abnormal CCI, and 311 (15%) in subjects with both abnormal TnT/CCI. The highest risk of death/MI occurred in patients with both abnormal TnT/CCI (OR, 4.4; 95% CI, 3.4 - 5.7; P < 0.001), suggesting that abnormal TnT is predictive of outcome in patients with abnormal CCI. Even after adjusting for age > 65 yrs, weight > 90 kg, ST depression, history of angina, MI, CHF, diabetes, hyperlipidemia, HTN, smoking, PCI, CABG, stroke, and treatment with lib/Ilia, patients with both abnormal TnT/ CCI had the highest risk of death/MI (OR, 3.3; 95% CI, 2.5 - 4.5; P < 0.001). TnT was pre- dictive of outcome across the entire spectrum of CCI (Figure 1 ). 35 i ~Abnormal Troponin 2 3° , ........ :o::: ~ 20 -.-- NO~ 81Troponbn .~ 15 upper 1o , Lower j 5 0 Conclusion: The prognostic value of TnT is not decreased in patients with impaired renal function who present with suspected ACS. ABSTRACTS - Myocardial Infarction and Ischemia 305A 3:15 p.m 822-6 Elevated Serum Myoglobin Is Associated With Increased Long-Term Mortality, Independent of Cardiac Troponin I, Electrocardiographic Variables, and Other Baseline Variables: Combined Analyses From TIM111B and TACTICS/TIM118 James A. de I._emos.David A. Morrow, Michael Gibson, $abina A. Murphy, Nader Rifai, Mark S. Sabatine, Howard A. Cooper, Carolyn H. McCabe, Elliott M. Antman, Christopher P. Cannon, Eugene Braunwald, University of Texas Southwestern Medical School, Dallas, Texas, TIMI Study Group, Boston, Massachusetts. Myoglobin (MYO) is a sensitive, but nonspecdic early marker of myocardial injury. Few studies have considered the prognostic implications of increased MYO among pts with non-ST elevation acute coronary syndromes (ACS). Methods: Baseline levels of MYO, cTnl, and CKMB were measured in 616 pts from TIMI 11B and 1841 pts from TACTICS/TIMI t 8 (ACS:180, Bayer Diagnostics). Mortality at 6 months was compared between pts with MYO levels above and below the recommended diagnostic threshold (110 ~g/L). Results: Pts with elevated baseline MYO were older, more often male, and more likely to present with MI (vs unstable angina), ECG changes, increased CKMB and increased cTnl (p<0.01 for each variable). In multivariate analyses adjusting for index diagnosis, baseline variables, ECG changes, cTnl, and CKMB, elevated baseline MYO remained associated with higher 6-month mortality: TIMI 11B adjusted OR 2.9 [1.2-7.0]; TACTICS/ TIMI 18 adjusted OR 2.7 [1.4-5.2]; combined dataset adjusted OR 2.8 [1.7-4.7]. There was no consistent association between MYO and nonfatal MI or recurrent ischemic events. Conclusions: In two distinct groups of pts with ACS, elevated baseline myoglobin was associated with a statistically significant near 3-fold increase in the risk for long-term mor- tality, independent of other baseline risk predictors, including age, diabetes, ECG changes and biomarkers such as cTnl and CKMB. These findings suggest that myoglo- bin should be added to the panel of biomarkere routinely measured in pts with ACS. P<0,0001 t214 t 12' i Z 1° 1 6 ~ Z • MYO ~ 110 ~MYO>110 P<0.0001 8.9 P<O.O001 8.6 TIM111B TACTICS COMBINED ORAL CONTRIBUTIONS 828 Enhancing Fibrinolysis: Combination With Newer Antiplatelet and Antithrombotic Agents Monday,March 18, 2002, 2:00 p.m.-3:30p.m. Georgia World Congress Center, Room 256W 2:00 p.m. 828-1 Prevention of Reinfarction Using Half-Dose Reteplase and Abciximab: Observation From the GUSTO-5 Trial E. Maanus Qhman, Robert M. Califf, Michael Lincoff, Paul Armstrong, Neal Kleiman, Judith Hochman, Harvey White, Stefano Savonifto, Marion Piedmonte, Joan Booth, Eric J. Topoi, The University of North Carolina, Chapel Hill, North Carolina, The Cleveland Clinic Foundation, Cleveland, Ohio. Background: An important caveat to successful reperfusion in acute myocardial infarction has been reinfarction occudng early after administration of fibrinotytic therapy. Reinfarc- tions are associated with major morbidity and a high mortality. The impact of newer com- bination reperfusion therapies on reinfarction rates remains to be determined. Methods: We examined the rate of reinfarction among patients randomized to either r-PA (10+10u) or low-dose r-PA (5+5u) and full dose abciximab in the GUSTO-5 trial. Results: A total of 479 patients (2.9%) had a reinfarction through discharge or 7 days, whichever was sooner. Patients randomized to combination therapy had significantly lower rate of reinf- arction compared with r-PA alone (2.3% vs 3.5%, p<O.0001). Reinfarctions within the first 24 hours of randomization were more common among patients treated with r-PA (29% of all patients with reinfarctions after r-PA) compared with combination therapy (19%). Cer- tain baseline characteristics were more common among patients with reinfarction versus those without, such as the elderly (over 75 years: 19% vs 13%), females (30% vs 25%), and in patients with prior MI (24% vs 15%), but less common among current smokers (33% vs 46%). In an adjusted analysis, patients randomized to combination therapy were less likely to suffer reinfarction (Odds Ratio: 0.67 95%Ch 0.56-0.80, p<0.001) compared to r-PA alone, even among patients who were more likely to have reinfarction such as older patients (p<O.O01), and those with previous M I (p<0.O01). Conclusions: Combina-