(Circulation. 1998;98:2004-2009.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Very Early Risk Stratification Using Combined ECG and Biochemical Assessment in Patients With Unstable Coronary Artery Disease (A Thrombin Inhibition in Myocardial Ischemia [TRIM] Substudy)
From the Heart Center, Rigshospitalet, Copenhagen (L.H., P.C., P.G.), and the Department of Cardiology, Aarhus Amtssygehus/Universitetshospital, Aarhus (M.S.L., K.T.), Denmark.
Correspondence to Lene Holmvang, MD, The Heart Center 2142, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
Background—The diagnostic capability of troponin T (TnT), troponin I (TnI), myoglobin, and creatine kinase (CK)-MB mass for detection of myocardial injury seems evident. Newer studies have found these sensitive markers to carry independent prognostic information in patients with unstable coronary artery disease as well. ST-segment depression in the admission ECG is known to be an important indicator of poor outcome in these patients. The present study investigates the prognostic capacities of the ECG in combination with biochemical admission measurements in 516 patients admitted to hospital with unstable coronary artery disease.
Methods and Results—Baseline ECG recordings and blood
samples were collected for central analysis. The patients were
followed up for 30 days, and predefined end points, ie, death,
myocardial infarction, and refractory angina, were registered as end
points. By univariate analysis, ST-segment
depression, inverted T waves in 
5 leads, TnT 0.1 µg/L, TnI 0.5
µg/L, myoglobin 40 µg/L, female sex, and age 65 years were
predictors of death and myocardial infarction at 30 days. By
multivariate analysis, female sex, ST-segment
depression at randomization, or inverted T-waves in 5 leads were the
only independent predictors of death or myocardial infarction. On the
basis of baseline ECG ST-T changes and CK-MB mass/TnT/TnI/myoglobin
levels, the patients were divided into 3 subgroups at high (14% event
rate), intermediate (6%), and low (3%) risk of early death/myocardial
infarction.
Conclusions—The present study found the combination of baseline values of TnT, TnI, CK-MB mass, and ST-T changes in the ECG to be effective for early risk stratification in patients with unstable coronary artery disease.
Key Words: prognosis • angina • electrocardiography • myoglobin • creatine kinase • troponin
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