(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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E. Giannitsis, M. Muller-Bardorff, V. Kurowski, B. Weidtmann, U. Wiegand, M. Kampmann, and H. A. Katus Independent Prognostic Value of Cardiac Troponin T in Patients With Confirmed Pulmonary Embolism Circulation, July 11, 2000; 102(2): 211 - 217. [Abstract] [Full Text] [PDF]
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C. W. Hamm and E. Braunwald A Classification of Unstable Angina Revisited Circulation, July 4, 2000; 102(1): 118 - 122. [Abstract] [Full Text] [PDF]
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C. Heeschen, B.U. Goldmann, W. Terres, and C.W. Hamm Cardiovascular risk and therapeutic benefit of coronary interventions for patients with unstable angina according to the troponin T status Eur. Heart J., July 2, 2000; 21(14): 1159 - 1166. [Abstract] [PDF]
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P O Collinson, S Premachandram, K Hashemi, and R L. Kennedy Prospective audit of incidence of prognostically important myocardial damage in patients discharged from emergency department Commentary: Time for improved diagnosis and management of patients presenting with acute chest pain BMJ, June 24, 2000; 320(7251): 1702 - 1705. [Abstract] [Full Text]
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E. Boersma, K. S. Pieper, E. W. Steyerberg, R. G. Wilcox, W.-C. Chang, K. L. Lee, K. M. Akkerhuis, R. A. Harrington, J. W. Deckers, P. W. Armstrong, et al. Predictors of Outcome in Patients With Acute Coronary Syndromes Without Persistent ST-Segment Elevation : Results From an International Trial of 9461 Patients Circulation, June 6, 2000; 101(22): 2557 - 2567. [Abstract] [Full Text] [PDF]
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K.a. Safstrom, B. Lindahl, E. Swahn, and the FRISC-Study Group Risk stratification in unstable coronary artery disease: Exercise test and troponin T from a gender perspective J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1791 - 1800. [Abstract] [Full Text] [PDF]
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C. R. deFilippi, M. Tocchi, R. J. Parmar, S. Rosanio, G. Abreo, M. A. Potter, M. S. Runge, and B. F. Uretsky Cardiac troponin T in chest pain unit patients without ischemic electrocardiographic changes: angiographic correlates and long-term clinical outcomes J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1827 - 1834. [Abstract] [Full Text] [PDF]
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P Abrahamsson, A Rosengren, and M Dellborg Improved long-term prognosis for patients with unstable coronary syndromes 1988-1995 Eur. Heart J., April 1, 2000; 21(7): 533 - 539. [Abstract] [PDF]
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J. Ravkilde Risk Stratification in Acute Coronary Syndrome Using Cardiac Troponin I Clin. Chem., April 1, 2000; 46(4): 443 - 444. [Full Text] [PDF]
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D. S. Ooi, P. A. Isotalo, and J. P. Veinot Correlation of Antemortem Serum Creatine Kinase, Creatine Kinase-MB, Troponin I, and Troponin T with Cardiac Pathology Clin. Chem., March 1, 2000; 46(3): 338 - 344. [Abstract] [Full Text] [PDF]
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Y. Yeghiazarians, J. B. Braunstein, A. Askari, and P. H. Stone Unstable Angina Pectoris N. Engl. J. Med., January 13, 2000; 342(2): 101 - 114. [Full Text] [PDF]
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S. Fuchs, R. Kornowski, R. Mehran, L. F. Satler, A. D. Pichard, K. M. Kent, M. K. Hong, S. Slack, G. W. Stone, and M. B. Leon Cardiac troponin I levels and clinical outcomes in patients with acute coronary syndromes: The potential role of early percutaneous revascularization J. Am. Coll. Cardiol., November 15, 1999; 34(6): 1704 - 1710. [Abstract] [Full Text] [PDF]
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C.W. Hamm Unstable angina: the breakthrough Eur. Heart J., November 1, 1999; 20(21): 1517 - 1519. [PDF]
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P. Porela, H. Helenius, K. Pulkki, and L.-M. Voipio-Pulkki Epidemiological classification of acute myocardial infarction: time for a change? Eur. Heart J., October 2, 1999; 20(20): 1459 - 1464. [Abstract] [PDF]
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T. Mathew, I. Menown, B. Smith, M. Smye, S. Nesbitt, I. Young, and A.A.J. Adgey Diagnosis and risk stratification of patients with anginal pain and non-diagnostic electrocardiograms QJM, October 1, 1999; 92(10): 565 - 571. [Abstract] [Full Text] [PDF]
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C. Heeschen, B. U. Goldmann, L. Langenbrink, G. Matschuck, and C. W. Hamm Evaluation of a Rapid Whole Blood ELISA for Quantification of Troponin I in Patients with Acute Chest Pain Clin. Chem., October 1, 1999; 45(10): 1789 - 1796. [Abstract] [Full Text] [PDF]
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T. M. Hurst, M. Hinrichs, C. Breidenbach, N. Katz, and B. Waldecker Detection of myocardial injury during transvenous implantation of automatic cardioverter-defibrillators J. Am. Coll. Cardiol., August 1, 1999; 34(2): 402 - 408. [Abstract] [Full Text] [PDF]
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L. P. Roppolo, R. Fitzgerald, J. Dillow, T. Ziegler, M. Rice, and A. Maisel A comparison of troponin T and troponin I as predictors of cardiac events in patients undergoing chronic dialysis at a Veteran's Hospital: a pilot study J. Am. Coll. Cardiol., August 1, 1999; 34(2): 448 - 454. [Abstract] [Full Text] [PDF]
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C. Lowbeer, A. Ottosson-Seeberger, S. A. Gustafsson, R. Norrman, J. Hulting, and A. Gutierrez Increased cardiac troponin T and endothelin-1 concentrations in dialysis patients may indicate heart disease Nephrol. Dial. Transplant., August 1, 1999; 14(8): 1948 - 1955. [Abstract] [Full Text] [PDF]
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J. C. Stolear, B. Georges, A. Shita, and D. Verbeelen The predictive value of cardiac troponin T measurements in subjects on regular haemodialysis Nephrol. Dial. Transplant., August 1, 1999; 14(8): 1961 - 1967. [Abstract] [Full Text] [PDF]
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M. Muller-Bardorff, T. Rauscher, M. Kampmann, S. Schoolmann, F. Laufenberg, D. Mangold, R. Zerback, A. Remppis, and H. A. Katus Quantitative Bedside Assay for Cardiac Troponin T: A Complementary Method to Centralized Laboratory Testing Clin. Chem., July 1, 1999; 45(7): 1002 - 1008. [Abstract] [Full Text] [PDF]
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A. H.B. Wu, F. S. Apple, W. B. Gibler, R. L. Jesse, M. M. Warshaw, and R. Valdes Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: Recommendations for the Use of Cardiac Markers in Coronary Artery Diseases Clin. Chem., July 1, 1999; 45(7): 1104 - 1121. [Abstract] [Full Text] [PDF]
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C. W. Hamm, C. Heeschen, B. Goldmann, A. Vahanian, J. Adgey, C. M. Miguel, W. Rutsch, J. Berger, J. Kootstra, M. L. Simoons, et al. Benefit of Abciximab in Patients with Refractory Unstable Angina in Relation to Serum Troponin T Levels N. Engl. J. Med., May 27, 1999; 340(21): 1623 - 1629. [Abstract] [Full Text] [PDF]
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B. L. Norgaard, K. Andersen, M. Dellborg, P. Abrahamsson, J. Ravkilde, K. Thygesen, and for the TRIM study group Admission risk assessment by cardiac troponin T in unstable coronary artery disease: additional prognostic information from continuous ST segment monitoring J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1519 - 1527. [Abstract] [Full Text] [PDF]
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M. C. Kontos, R. L. Jesse, F. P. Anderson, K. L. Schmidt, J. P. Ornato, and J. L. Tatum Comparison of Myocardial Perfusion Imaging and Cardiac Troponin I in Patients Admitted to the Emergency Department With Chest Pain Circulation, April 27, 1999; 99(16): 2073 - 2078. [Abstract] [Full Text] [PDF]
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J. Zimmerman, R. Fromm, D. Meyer, A. Boudreaux, C.-C. C. Wun, R. Smalling, B. Davis, G. Habib, and R. Roberts Diagnostic Marker Cooperative Study for the Diagnosis of Myocardial Infarction Circulation, April 6, 1999; 99(13): 1671 - 1677. [Abstract] [Full Text] [PDF]
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