Copyright © 2003 by the European Society of Cardiology.
Elevated troponin T and C-reactive protein predict impaired outcome for 4 years in patients with refractory unstable angina, and troponin T predicts benefit of treatment with abciximab in combination with PTCA
a Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, Rotterdam,The Netherlands
b Stanford University School of Medicine, California, USA
c Kerckhoff Heart Center, Bad-Neuheim, Germany
d The Tenon Hospital, Paris, France
e Hospital De Weezenlanden, Zwolle, The Netherlands
f Medical Centre Alkmaar, Alkmaar, The Netherlands
Received April 29, 2003; accepted May 1, 2003 * Correspondence: Prof. Dr Maarten L. Simoons, Thoraxcentre, Department of Cardiology, Erasmus Medical Centre Rotterdam: room H560: Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
Aims Treatment with the glycoprotein IIb/IIIa receptor antagonist abciximab before and during coronary intervention in refractory unstable angina improves early outcome. We collected 4-year follow-up data to assess whether this benefit is sustained. Additionally, we investigated the predictive value of baseline troponin T and CRP for long-term cardiovascular events.
Methods and Results Of 1265 patients enrolled in the CAPTURE trial follow-up was available in 94% of the patients alive after 6 months (median 48 months). Survival was similar in both groups. Both elevated troponin T and CRP were associated with impaired outcome, independently of other established risk factors, but with a different time course. Elevated troponin was associated with increased procedure related risk, and elevated CRP with increased risk for subsequent events. Lower rates of the composite end-point of death or myocardial infarction with abciximab vs. placebo were sustained during long-term follow up: 15.7% vs 17.2% at 4 years (P=ns), particularly in patients with elevated troponin T: 16.9% with abciximab vs 28.4% with placebo: P=0.015. Elevated CRP was not associated with specific benefit of abciximab.
Conclusion Troponin T as a marker of thrombosis and CRP as a marker of inflammation are independent predictors of impaired outcome at 4 years follow-up. The initial benefit from abciximab with regard to death and myocardial infarction was preserved at 4 years. No specific benefit with abciximab was observed for patients with elevated CRP, suggesting that a chronic inflammatory process is not affected by abciximab. In contrast the benefit of treatment in patients with elevated troponin T implies that the acute thrombotic process in refractory unstable angina is treated effectively.
Key Words: Glycoprotein IIb/IIIa receptor antagonist • unstable angina pectoris • troponin T • C-reactive protein • long-term follow-up
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