Maximal troponin T levels in the first 24 hours independently predicted 5-month risk of myocardial infarction or cardiac death, rising from 4.3% in the lowest quintile to 16.1% in the highest.
RCT (n=976)
Does maximal troponin T level in the first 24 hours predict the risk of myocardial infarction or cardiac death in patients with unstable coronary artery disease?
Maximal troponin T levels obtained during the first 24 hours provide independent prognostic information for the risk of myocardial infarction or cardiac death in patients with unstable coronary artery disease.
Absolute Event Rate: 16.1% vs 4.3%
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 ( or =0.18 microgram/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.
Lindahl et al. (1996) conducted an RCT in Unstable coronary artery disease (unstable angina or non-Q-wave myocardial infarction) (n=976). Troponin T (tn-T) levels vs. Lowest quintile (<0.06 microgram/L) was evaluated on Myocardial infarction or cardiac death. Maximal troponin T levels in the first 24 hours independently predicted 5-month risk of myocardial infarction or cardiac death, rising from 4.3% in the lowest quintile to 16.1% in the highest.