Short- and long-term prognostic value of cardiac troponin I and dobutamineechocardiography in patients with stabilized acute coronary syndromes

Background: This study investigated the short- and long-term prognostic val ues of cardiac troponin I (cTnI) and dobutamine echocardiography (DE) in pa tients with acute coronary syndrome (ACS) who stabilized after medical trea tment. Methods and results: 171 consecutive patients of ACS accepted blood sampling for cTnI at the emergency department and DE at 4.9 +/- 0.6 days af ter admission. The prognostic values of cTnI DE, and combined cTnI and DE w ere separately investigated at follow up periods of 30 days, 1 year and 3 y ears for hard events (cardiac death and non-fatal myocardial infarction) an d all spontaneous events. CTnI was elevated in 55 (32%) patients and DE was positive in 114 (67%) patients. Elevated cTnI with positive DE were found in 44 (26%) patients. Within 30 days, the combination of elevated cTnI and positive DE provided more accurate prognostic information than each test re sult alone, and was the only independent predictor for both hard (p = 0.014 ) and all events (p = 0.012). After 1 year, cTnI alone had no prognostic va lue. The combination of an elevated cTnI level and a positive DE only had a prognostic value for all events (p = 0.015). However, DE was an independen t predictor for both hard (p = 0.006) and all events (p = 0.002). Neither c TnI alone nor cTnI combined with DE had a significant 3-year prognostic val ue. However, DE maintained its prognostic value and was still an independen t predictor after 3 years for both hard (p = 0.024) and all events (p = 0.0 04). Conclusions: For patients with stabilized ACS, the diagnostic finding of elevated cTnI combined with a positive DE has a better short-term progno stic value than each test alone. However, DE alone has a better long-term p rognostic value. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved .