Risk stratification in unstable coronary artery disease - Exercise test and troponin T from a gender perspective

OBJECTIVES The study was done to determine the prognostic yield of an early symptom-limited exercise test (ET) and measurement of troponin T (TnT) in men and women with unstable coronary artery disease (CAD), with special ref erence to gender differences. BACKGROUND Early risk assessment is essential for the application of approp riate treatment and further management in patients with unstable CAD. The e arly symptom-limited ET together with specific biochemical marker determina tion is an inexpensive, widely applicable method for early risk stratificat ion. In women, however, the ET is considered less reliable, and there are f ew data on biochemical markers for risk stratification in women. METHODS In a substudy of the Fragmin during InStability in Coronary artery disease (FRISC I) trial, 395 women and 778 men with unstable CAD who perfor med an early ET were followed for six months. Blood samples for TnT determi nation were taken in 342 women and 621 men at inclusion. RESULTS Based on the ET results, low-, intermediate-, and high-risk respons e groups were identified with event rates of cardiac death or myocardial in farction (MI) of 1%, 9%, and 19%, respectively, among women and 8%, 14%, an d 20%, respectively, among men. Patients who could not perform the ET had a n event rate similar to the high-risk group. The TnT levels were divided in to three groups: <0.06, 0.06-0.19, and greater than or equal to 0.20 mu g/l iter with event rates of 1%, 10%, and 18%, respectively, among women and 9% , 14%, and 18%, respectively, among men. Combining the ET results with TnT levels identified a low-risk group with an event rate of 3% in the male pop ulation and no events in the female population. CONCLUSIONS Direct comparison between men and women from the same populatio n with a high pretest likelihood of disease suggests that bath TnT and the early symptom-limited ET are at least as useful as prognostic risk indicato rs in women as they are in men. (J Am Coll Cardiol 2000; 35:1791-800) (C) 2 000 by the American College of Cardiology.