PROSPECTIVE-STUDY OF THE ROLE OF CARDIAC TROPONIN-T IN PATIENTS ADMITTED WITH UNSTABLE ANGINA

Objective-To examine the prognostic significance and role in risk stra tification of the biochemical marker troponin T in patients admitted w ith unstable angina. Design-Single centre, blinded, prospective study of patients admitted with chest pain. Setting-Coronary care unit of a district general hospital. Subjects-460 patients admitted with chest p ain and followed up for a median of three years. 183 patients had a fi nal diagnosis of unstable angina. Main outcome measures-Cardiac death, need for coronary revascularisation, or readmission with non-fatal my ocardial infarction as first events. Results-62 (34%) unstable angina patients were troponin T positive. This group had significantly increa sed incidence rates of subsequent cardiac death (12 cases (19%) v 14 ( 12%)), coronary revascularisation (22 (35%) v 26 (21%)), death or reva scularisation (33 (53%) v 40 (33%)), and death or non-fatal myocardial infarction (18 (29%) v 21 (17%)) compared with the troponin T negativ e group. In multiple logistic regression troponin T status was a highl y significant predictor for the end points coronary revascularisation and cardiac death or revascularisation as first events. Conclusion-Tro ponin T in the serum of patients with unstable angina identifies a sub group at higher risk of subsequent cardiac events and its measurement aids in risk factor stratification. The increased risk extends to two years after admission. Prospective randomised trials are required to i dentify optimum therapeutic strategies for this subgroup.