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European Heart Journal 2000 21(14):1159-1166; doi:10.1053/euhj.1999.1986
Copyright © 2000 by the European Society of Cardiology.
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Cardiovascular risk and therapeutic benefit of coronary interventions for patients with unstable angina according to the troponin T status

C. Heeschena,f1, B.U. Goldmannb, W. Terresb and C.W. Hammb

a Stanford University School of Medicine, Division of Cardiovascular Medicine, California, U.S.A.
b Department of Cardiology, Hamburg University, Germany
Department of Cardiology, General Hospital Celle, Germany
Department of Cardiology, Kerckhoff-Clinic, Bad Nauheim, Germany

revised October 19, 1999; accepted October 20, 1999

Abstract

Aims Elevation of troponin T in patients with unstable angina is predictive of adverse outcomes. Since no advanced therapeutic concept for such high-risk patients has been established, we investigated cardiac risk prior to, during, and after coronary revascularization in patients with unstable angina stratified according to the troponin T status.

Methods and Results Out of 351 patients with unstable angina, troponin was elevated for 36% of the patients as determined by qualitative bedside tests. The patients were followed during hospitalization and 30 days after discharge for incidence of death and myocardial infarction. In troponin-positive patients, clinical symptoms were more refractory to medical treatment than in troponin-negative patients (78% vs 44%;P=0·002). Although these patients were catheterized earlier (1·6 vs 3·4 days;P=0·005) and more frequently (95% vs 69%;P<0·001), troponin-positive patients suffered a higher incidence of cardiac events prior to scheduled revascularization (death, myocardial infarction; 6·4% vs 0·4%;P<0·001). The angiogram for troponin-positive patients confirmed a more severe coronary artery disease requiring revascularization (69% vs 50%;P=0·001). Also the following coronary intervention was more complicated (death, myocardial infarction; 15·3% vs 4·8%;P=0·02). During the 30-day follow-up period, cardiac risk remained elevated for troponin-positive patients.

Conclusions Troponin T rapid testing reliably identified high-risk patients with unstable angina. A higher event rate was observed prior to and particularly in association with the coronary intervention. Coronary revascularization did not abrogate the increased risk of troponin-positive patients during the 30-day follow-up.

Key Words: Unstable angina, troponin T, coronary intervention, prognosis

f1 Correspondence: Dr Christopher Heeschen, Stanford University School of Medicine, Division of Cardiovascular Medicine, Stanford, CA, U.S.A.

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