(Circulation. 1996;93:1651-1657.)
© 1996 American Heart Association, Inc.
Articles |
Relation Between Troponin T and the Risk of Subsequent Cardiac Events in Unstable Coronary Artery Disease
From the Department of Cardiology and Department of Clinical Chemistry, University of Uppsala, Sweden.
Correspondence to Bertil Lindahl, MD, Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden. E-mail lars.wallentin@thorax.uas.se; E-mail helene.strombom@thorax.uas.se.
Background Early risk assessment is important in patients with unstable coronary artery disease, ie, unstable angina or non–Q-wave myocardial infarction. Some previous small studies have indicated that patients with unstable angina and elevation of troponin T (tn-T) have worse short-term and long-term prognoses. In this study, the prognostic value of tn-T was evaluated and compared with other early available risk indicators.
Methods and Results Nine hundred seventy-six patients
participating in a randomized study of low-molecular-weight
heparin in unstable coronary artery disease were followed for 5
months after the index episode. The risk of cardiac events increased
with increasing maximal levels of tn-T obtained in the initial 24
hours. The lowest quintile (<0.06 µg/L) constituted a low-risk
group, the second quintile (0.06 to 0.18 µg/L) an
intermediate-risk group, and the three highest quintiles (
0.18
µg/L) a high-risk group, with 4.3%, 10.5%, and 16.1% risk of
either myocardial infarction or cardiac death, respectively. Troponin T
level was identified together with age, hypertension, number of
antianginal drugs, and ECG changes at rest as independent prognostic
variables for myocardial infarction or cardiac death in a
multivariate analysis. The prognostic value of
tn-T was independent of the classification of index event into unstable
angina or myocardial infarction.
Conclusions Troponin T determination is an inexpensive and widely applicable method for early risk assessment in patients with unstable coronary artery disease. The maximum tn-T value obtained during the first 24 hours provides independent and important prognostic information.
Key Words: coronary disease • prognosis • heparin • myocardial infarction
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