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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
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Kardiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Kardiologi)
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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
Abstract [en]

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.
Keyword [en]
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
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Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-71856DOI: 10.1067/mhj.2002.121733PubMedID: 12040335OAI: oai:DiVA.org:uu-71856DiVA: diva2:99767
Available from: 2005-05-13 Created: 2005-05-13 Last updated: 2017-11-21Bibliographically approved

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Andrén, BertilGenberg, MargaretaJernberg, TomasLagerqvist, BoLindahl, BertilVenge, PerWallentin, Lars

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