The prognostic and therapeutic implications of increased troponin T levels and ST depression in unstable coronary artery disease: the FRISC II invasive troponin T electrocardiogram substudy
2002 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 143, no 5, 760-767 p.Article in journal (Refereed) Published
BACKGROUND: In unstable coronary artery disease, both increased troponin T level and occurrence of ST-segment depression are associated with a worse prognosis. In the Fast Revascularisation in InStability in Coronary disease trial II invasive study, we evaluated whether the troponin T level, alone and combined with ST depression, identified more severe coronary artery disease or a greater efficacy of an early invasive strategy.
METHODS: In the study, 2457 patients with unstable coronary artery disease were randomized to early invasive or noninvasive strategy. Troponin T value and admission electrocardiogram results were available in 2286 patients.
RESULTS: In the noninvasive cohort, death or myocardial infarction occurred in 16.6% with troponin T level > or =0.03 microg/L versus 8.5% with troponin T level < 0.03 microg/L (P <.001). In the invasive group, 49% of patients with both ST depression and troponin T level > or =0.03 microg/L had 3-vessel or left main disease compared with 17% if neither finding was present (P <.001). The invasive strategy reduced death/myocardial infarction at 12 months in the cohort with both ST depression and troponin T level > or =0.03 microg/L from 22.1% to 13.2% (risk ratio, 0.60; 95% confidence interval, 0.43 to 0.82; P =.001). In the cohort with either ST depression or troponin T level > or =0.03 microg/L or neither of these findings, the absolute gain of the invasive strategy was smaller and more uncertain.
CONCLUSION: Patients with unstable coronary artery disease with the combination of troponin T level > or =0.03 microg/L and ST depression have a poor prognosis and, in half of the cases, 3-vessel or left main disease. In these patients, an early invasive strategy will substantially reduce death/myocardial infarction.
Place, publisher, year, edition, pages
2002. Vol. 143, no 5, 760-767 p.
Aged, Biological Markers/blood, Cohort Studies, Confidence Intervals, Coronary Disease/*blood/*physiopathology/therapy, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction/etiology/mortality, Prognosis, Regression Analysis, Research Support; Non-U.S. Gov't, Tedelparin/therapeutic use, Troponin T/*blood
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-71856DOI: 10.1067/mhj.2002.121733PubMedID: 12040335OAI: oai:DiVA.org:uu-71856DiVA: diva2:99767