Admission risk assessment by cardiac troponin T in unstable coronary artery disease: Additional prognostic information from continuous ST segment monitoring

OBJECTIVES We investigated whether the addition of 24 h of continuous vectorcardiograp hy ST segment monitoring (cVST) for an early(within 24 h of the latest epis ode of angina) determination of cardiac troponin T (cTnT) could provide add itional prognostic information in patients with unstable coronary artery di sease (UCAD), i.e., unstable angina and non-Q wave myocardial infarction. BACKGROUND Determination of cTnT at admission and cVST are individually reported to be valuable techniques for the risk assessment of patients with UCAD. METHODS Two hundred and thirty-two patients suspected of UCAD were studied. Patient s were followed for 30 days, and the occurrence of cardiac death or acute m yocardial infarction (AMI) were registered. RESULTS One ST segment episode or more (relative risk [RR] 7.43, p = 0.012), a cTnT level greater than or equal to 0.20 mu g/liter (RR 3.85, p = 0.036) or pre study medication with calcium antagonists (RR 3.31, p = 0.041) were found t o carry independent prognostic information after multivariate analysis of p otential risk variables. By combining a cTnT determination and subsequent c VST for 24 h, subgroups of patients at high (25.8%) (n = 31), intermediate (3.1%) (n = 65) and low risk (1.7%) (n = 117) of death or AMI could be iden tified. CONCLUSIONS Twenty-four hours of cVST provides additional prognostic information to tha t of an early cTnT determination in patients suspected of having UCAD. The combination of biochemical and electrocardiographic methods provides powerf ul and accurate risk stratification in UCAD. (C) 1999 by the American Colle ge of Cardiology.