Troponin T identifies patients with unstable coronary artery disease who benefit from long-term antithrombotic protection. Fragmin in Unstable Coronary Artery Disease (FRISC) Study Group

Department of Cardiology, University of Uppsala, Sweden.

OBJECTIVES: We sought to evaluate whether troponin T might be used for identification of patients with unstable coronary artery disease in whom treatment with low molecular weight heparin is beneficial. BACKGROUND: Early identification of subgroups with differences in response to a certain treatment is important to optimize the utilization of different therapeutic approaches. METHODS: Nine-hundred seventy-one patients with unstable coronary artery disease who participated in a trial of the low molecular weight heparin dalteparin (Fragmin) and who provided blood samples were classified into subgroups according to troponin T level. In the short-term phase all patients received subcutaneous dalteparin/placebo twice daily for 6 days. During the long-term phase they continued with daltparin/placebo once daily for another 5 weeks. RESULTS: In the short-term phase, dalteparin reduced the incidence of death or myocardial infarction from 2.4% to 0% (p = 0.12) and from 6.0% to 2.5% (p < 0.05) in 327 and 644 patients with troponin T levels < 0.1 and > or = 0.1 micrograms/liter, respectively. During long-term treatment there was an increasing difference between the placebo and dalteparin group in those with troponin T levels > or = 0.1 microgram/liter, in whom the incidences at 40 days were 14.2% and 7.4%, respectively (p < 0.01). In contrast, no beneficial effect of the long-term treatment could be demonstrated in those with troponin T levels < 0.1 microgram/liter (4.7% vs. 5.7%). CONCLUSIONS: Elevation of troponin T identifies a subgroup of patients in whom prolonged antithrombotic treatment (e.g., with dalteparin) is beneficial.

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				M. Muller-Bardorff, T. Rauscher, M. Kampmann, S. Schoolmann, F. Laufenberg, D. Mangold, R. Zerback, A. Remppis, and H. A. Katus Quantitative Bedside Assay for Cardiac Troponin T: A Complementary Method to Centralized Laboratory Testing Clin. Chem., July 1, 1999; 45(7): 1002 - 1008. [Abstract] [Full Text] [PDF]

				A. H.B. Wu, F. S. Apple, W. B. Gibler, R. L. Jesse, M. M. Warshaw, and R. Valdes Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: Recommendations for the Use of Cardiac Markers in Coronary Artery Diseases Clin. Chem., July 1, 1999; 45(7): 1104 - 1121. [Abstract] [Full Text] [PDF]

				S KENNON and A TIMMIS Management of unstable angina: what role intervention, ask the RITA-3 trialists? Heart, June 1, 1999; 81(6): 565 - 566. [Full Text]

				C. W. Hamm, C. Heeschen, B. Goldmann, A. Vahanian, J. Adgey, C. M. Miguel, W. Rutsch, J. Berger, J. Kootstra, M. L. Simoons, et al. Benefit of Abciximab in Patients with Refractory Unstable Angina in Relation to Serum Troponin T Levels N. Engl. J. Med., May 27, 1999; 340(21): 1623 - 1629. [Abstract] [Full Text] [PDF]

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				M. C. Kontos, R. L. Jesse, F. P. Anderson, K. L. Schmidt, J. P. Ornato, and J. L. Tatum Comparison of Myocardial Perfusion Imaging and Cardiac Troponin I in Patients Admitted to the Emergency Department With Chest Pain Circulation, April 27, 1999; 99(16): 2073 - 2078. [Abstract] [Full Text] [PDF]

				D. A. Halon, M. Y. Flugelman, A. Merdler, H. Rennert, J. Shahla, and B. S. Lewis Long-term (10-year) outcome in patients with unstable angina pectoris treated by coronary balloon angioplasty J. Am. Coll. Cardiol., November 15, 1998; 32(6): 1603 - 1609. [Abstract] [Full Text] [PDF]

				L. Holmvang, M. S. Luscher, P. Clemmensen, K. Thygesen, and P. Grande Very Early Risk Stratification Using Combined ECG and Biochemical Assessment in Patients With Unstable Coronary Artery Disease (A Thrombin Inhibition in Myocardial Ischemia [TRIM] Substudy) Circulation, November 10, 1998; 98(19): 2004 - 2009. [Abstract] [Full Text] [PDF]

				L. K. Newby, R. H. Christenson, E. M. Ohman, P. W. Armstrong, T. D. Thompson, K. L. Lee, C. W. Hamm, H. A. Katus, C. Cianciolo, C. B. Granger, et al. Value of Serial Troponin T Measures for Early and Late Risk Stratification in Patients With Acute Coronary Syndromes Circulation, November 3, 1998; 98(18): 1853 - 1859. [Abstract] [Full Text] [PDF]

				P. W. Armstrong, Y. Fu, W.-C. Chang, E. J. Topol, C. B. Granger, A. Betriu, F. Van de Werf, K. L. Lee, R. M. Califf, and f. t. G.-I. Investigators Acute Coronary Syndromes in the GUSTO-IIb Trial : Prognostic Insights and Impact of Recurrent Ischemia Circulation, November 3, 1998; 98(18): 1860 - 1868. [Abstract] [Full Text] [PDF]

				R. H. Christenson and H. M. E. Azzazy Biochemical markers of the acute coronary syndromes Clin. Chem., August 1, 1998; 44(8): 1855 - 1864. [Abstract] [Full Text] [PDF]

				O. Hetland and K. Dickstein Cardiac troponins I and T in patients with suspected acute coronary syndrome: a comparative study in a routine setting Clin. Chem., July 1, 1998; 44(7): 1430 - 1436. [Abstract] [Full Text] [PDF]

				M. Carrier, L. C. Pelletier, R. Martineau, M. Pellerin, and B. C. Solymoss In elective coronary artery bypass grafting, preoperative troponin T level predicts the risk of myocardial infarction J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1328 - 1334. [Abstract] [Full Text] [PDF]