Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Risk stratification in unstable coronary artery disease
Additive value of troponin T determinations and pre-discharge exercise tests
*Department of Cardiology, University of Uppsala Sweden
Department of Clinical Physiology, University of Uppsala Sweden
Department of Clinical Physiology County Hospital Ryhov, Jönköping, Sweden
Department of Clinical Chemistry University of Uppsala Sweden
revised 21 November 1995; accepted 3 April 1996.
Correspondence: Bertil Lindahl, Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden
Abstract
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-discharge exercise test both troponin T level and exercise test response were independent predictors of prognosis. Cardiac death or myocardial infarction occurred in 5, 9 and 13% of the patients with a maximal troponin T level of <0·06 (n=154), 0·06–02 (n=175) and 
0·2 µg . 1–1 (n=437), respectively. Based on exercise tolerance and occurrence of ST depression, patients with a low (n=361), intermediate (n=325) and high risk (n=80) exercise test response were identified. 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), intermediate (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 patients with troponin T <0·06, 0·06–0·2 and 0·2 µg . 1–1, respectively.
Thus, troponin T determinations and pre-discharge exercise tests alone and combined are valuable for risk assessment in unstable coronary artery disease.
Key Words: Unstable coronary artery disease • unstable angina pectoris • non-Q wave myocardial infarction • risk stratification • troponin T • exercise test
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