Copyright © 1998 by the European Society of Cardiology.
Troponin T in patients with low grade or atypical angina. Identification of a high risk group for short- and long-term cardiovascular events
a Department of Nephrology/Intensive Care Medicine, Charité/Virchow-Klinikum, Humboldt University, Berlin
b Department of Cardiology/Intensive Care Medicine, Karl Olga Hospital, Stuttgart
c Department of Medical Sociology, University Marburg, Marburg
d Department of Physiology, Free University Berlin, Berlin, Germany
e Department of Cardiovascular Imaging, Charité/Virchow-Klinikum, Humboldt University, Berlin
accepted July 12, 1998
Aims
Cardiac troponin T is an established marker of cardiovascular risk in patients with severe angina pectoris. Data are scarce on patients admitted to a coronary care unit with low grade or atypical angina pectoris to rule out myocardial infarction.
Methods and Results
We investigated 106 patients (57·4 SD 11·6 years) with low grade (Braunwald class I) or atypical symptoms out of 702 patients admitted to the coronary care unit with suspected acute myocardial infarction. Serum concentrations of troponin T were measured at admission and 4h later. In hospital cardiovascular events including acute myocardial infarction, life threatening cardiac arrhythmias, congestive heart failure, and death were recorded. Patients were additionally observed after 3 and 6 months post-discharge regarding acute myocardial infarction, unstable angina, rehospitalization for cardiac causes and death. The patients were divided into a troponin T positive (
0·2µg.l–1at admission or 4h later; n=11) and a troponin T negative group. The mean value of troponin T 4h after admission in the positive group was 0·58µg.l–1.
Of the troponin T positive patients, 0·82 (0·95 CI: 0·48–0·98) had a cardiovascular event during their stay in hospital vs 0·41 (0·95 CI: 0·31–0·52) of troponin T negative patients (P<0·05). In the troponin T positive group 0·64 (0·95 CI: 0·31–0·89) developed myocardial infarction in hospital vs 0·07 (0·95 CI: 0·03–0·15) in the troponin T negative group (P<0·001). Troponin T predicts outcome after 3 and 6 months significantly (P<0·05).
Conclusion
Troponin T identifies patients with low grade or atypical angina at risk of severe short- and long-term cardiovascular events. Therefore, troponin T adds substantial information in patients with ruled out acute myo-cardial infarction. Troponin T positive patients have to be observed carefully regardless of their symptom intensity and may have to receive early cardiac catheterization; troponin T negative patients could be released safely from the coronary care unit early.
Key Words: Cardiac troponin T • risk of cardio-vascular events • rule out myocardial infarction • long-term follow-up
f1 Correspondence:Dr Martin Möckel, MD, Nephrology/Intensive Care Medicine, Charité/Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany.
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