THE FRISC EXPERIENCE WITH TROPONIN-T - USE AS DECISION TOOL AND COMPARISON WITH OTHER PROGNOSTIC MARKERS

Early prognostic evaluation is essential for the application of approp riate treatment and further management in the heterogeneous population with unstable coronary artery disease. Among the variety of prognosti c indicators that have been suggested, biochemical markers of myocardi al damage, especially the troponins: have gained increasing interest. The FRISC troponin T (TnT) substudy has validated and provided additio nal insights into the use of biochemical markers for prognostic evalua tion. Nine hundred and seventy-eight patients were enrolled and follow ed for 5 months. An increase in the rate of cardiac death or myocardia l infarction was seen during follow-up, with increasing levels of TnT. The TnT level separated low and high risk patients better than the co nventional division of unstable angina and myocardial infarction. In t he comparison with other early available risk indicators TnT was an in dependent risk indicator and gave additive prognostic information to b oth inclusion ECG and the result of a predischarge exercise test. TnT was superior to CK-MB for risk stratification, while TnT and troponin I showed comparable results. In patients with elevated TnT, treatment with dalteparin significantly decreased the risk for death or myocardi al infarction compared to placebo, while there was no benefit from dal teparin in patients without Tn-T elevation. Based on the experiences o f the FRISC study and the literature we suggest that the use of tropon ins should be included in the diagnostic and prognostic evaluation of patients with suspicion of unstable coronary artery disease.