OUP user menu

Risk stratification in unstable coronary artery disease
Additive value of troponin T determinations and pre-discharge exercise tests

B. Lindahl, B. Andrén, J. Ohlsson, P. Venge, L. Wallentin,
DOI: http://dx.doi.org/ 762-770 First published online: 1 May 1997

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.

  • Unstable coronary artery disease
  • unstable angina pectoris
  • non-Q wave myocardial infarction
  • risk stratification
  • troponin T
  • exercise test

Footnotes

  • ˙The FRISK study group investigators and their institutions are listed in the Appendix.

    • Revision received November 21, 1995.
    • Accepted April 3, 1996.