RISK STRATIFICATION IN UNSTABLE CORONARY-ARTERY DISEASE - ADDITIVE VALUE OF TROPONIN-T DETERMINATIONS AND PREDISCHARGE EXERCISE TESTS

In 963 patients, participating in a randomized study of low molecular weight heparin in unstable coronary artery disease and followed for 5 months, troponin T was determined. In the 766 patients with a pre-disc harge exercise test both troponin T level and exercise test response w ere independent predictors of prognosis. Cardiac death or myocardial i nfarction occurred in 5, 9 and 13% of the patients with a maximal trop onin T level of <0.06 (n=154), 0.06-0.2 (n=175) and greater than or eq ual to 0.2 mu g.l(-1) (n=437), respectively. Based on exercise toleran ce and occurrence of ST depression, patients with a low (n=361), inter mediate (n=325) and high risk (n=80) exercise test response were ident ified. In these, death or myocardial infarction occurred in 5, 13 and 29%, respectively. The combination of troponin T and the exercise test response allowed an even better categorization into low (n=84), inter mediate (n=406) and high (n=276 risk groups with 1, 7 and 20% death or myocardial infarction, respectively. Among those 197 patients unable to perform an exercise test the incidence was 3, 16 and 27% in patient s with troponin T <0.06, 0.06-0.2 and greater than or equal to 0.2 mu g.l(-1), respectively. Thus, troponin T determinations and pre-dischar ge exercise tests alone and combined are valuable for risk assessment in unstable coronary artery disease.