Cardiovascular risk and therapeutic benefit of coronary interventions for patients with unstable angina according to the troponin T status

Aims Elevation of troponin T in patients with unstable angina is predictive of adverse outcomes. Since no advanced therapeutic concept for such high-r isk patients has been established, we investigated cardiac risk prior to, d uring, and after coronary revascularization in patients with unstable angin a stratified according to the troponin T status. Methods and Results Out of 351 patients with unstable angina, troponin was elevated for 36% of the patients as determined by qualitative bedside tests . The patients were followed during hospitalization and 30 days after disch arge for incidence of death and myocardial infarction. In troponin-positive patients, clinical symptoms were more refractory to medical treatment than in troponin-negative patients (78% vs 44%; P=0.002). Although these patien ts were catheterized earlier (1.6 vs 3.4 days; P=0.005) and more frequently (95% vs 69%; P<0.001), troponin-positive patients suffered a higher incide nce of cardiac events prior to scheduled revascularization (death, myocardi al infarction; 6.4% vs 0.4%; P<0.001). The angiogram for troponin-positive patients confirmed a more severe coronary artery disease requiring revascul arization (69% vs 50%; P=0.001). Also the following coronary intervention w as more complicated (death, myocardial infarction; 15.3% vs 4.8%; P=0.02). During the 30-day follow-up period, cardiac risk remained elevated for trop onin-positive patients. Conclusions Troponin T rapid testing reliably identified high-risk patients with unstable angina. A higher event rate was observed prior to and partic ularly in association with the coronary intervention. Coronary revasculariz ation did not abrogate the increased risk of troponin-positive patients dur ing the 30-day follow-up. (Eur Heart J 2000; 21: 1159-1166) (C) 2000 The Eu ropean Society of Cardiology.