The combination of a continuous 12-lead ECG and troponin T - A valuable fool for risk stratification during the first 6 hours in patients with chest pain and a non-diagnostic ECG

Aims The aim was to examine the early prognostic value of a combination of a continuous 12-lead ECG and troponin T in patients with chest pain and an ECG non-diagnostic for acute myocardial infarction. Methods and Results ST monitoring was performed and samples for analysis of troponin T were collected from admission for 12 h from 598 patients. After 6 ht the peak value of troponin T in 27% was greater than or equal to 0.10 mu g. 1(-1), while 15% had had ST episodes, defined as transient ST deviat ions of at least 0.1 mV. Both a troponin T greater than or equal to 0.10 mu g 1(-1) and ST episodes predicted worsening outcome. After 30 days, there were 6.8% and 1.4% (P<0.01) cardiac deaths or myocardial infarctions in the group with and without troponin T greater than or equal to 0.10 mu g. 1(-1 ), respectively. The corresponding event rates in patients with and without ST episodes were 10% and 1.6% (P<0.001). in a multivariate analysis both t roponin T and ST episodes were independent predictors of cardiac death or m yocardial infarction. When ST monitoring and troponin T status were combine d, patients could be divided into low-, intermediate-, and high-risk groups . Conclusions A combination of continuous 12-lead monitoring and troponin T s eems to be a valuable tool for risk stratification during the first 6 h in this population. (C) 2000 The European Society of Cardiology.