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)

Background-The diagnostic capability of troponin T (TnT), troponin I ( TnT), myoglobin, and creatine kinase (CK)-MB mass for detection of myo cardial 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 i n these patients. The present study investigates the prognostic capaci ties of the ECG in combination with biochemical admission measurements in 516 patients admitted to hospital with unstable coronary artery di sease. Methods and Results-Baseline ECG recordings and blood samples w ere 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 an alysis, ST-segment depression, inverted T waves in greater than or equ al to 5 leads, TnT greater than or equal to 0.1 mu g/L, TnI greater th an or equal to 0.5 mu g/L, myoglobin greater than or equal to 40 mu g/ L, female sex, and age greater than or equal to 65 years were predicto rs of death and myocardial infarction at 30 days. By multivariate anal ysis, female sex, ST-segment depression at randomization, or inverted T-waves in greater than or equal to 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 patient s were divided into 3 subgroups at high (14% event rate), intermediate (6%), and low (3%) risk of early death/myocardial infarction. Conclus ions-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 ear ly risk stratification in patients with unstable corollary artery dise ase.