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CLINICAL STUDIES

Risk stratification in unstable coronary artery disease

Exercise test and troponin T from a gender perspective

K.åge Säfström, MD^*, Bertil Lindahl, PhD, Eva Swahn, PhD^* the FRISC-Study Group¹

^* Department of Cardiology, University Hospital, Linköping, Sweden
Department of Cardiology, University of Uppsala, Uppsala, Sweden

Manuscript received April 14, 1999; revised manuscript received December 30, 1999, accepted February 21, 2000.

Reprint requests and correspondence: Dr. Kåge Säfström, Department of Cardiology, University Hospital, SE 581 85 Linköping, Sweden
kage.safstrom{at}lio.se

OBJECTIVES

The study was done to determine the prognostic yield of an early symptom-limited exercise test (ET) and measurement of troponin T (TnT) in men and women with unstable coronary artery disease (CAD), with special reference to gender differences.

BACKGROUND

Early risk assessment is essential for the application of appropriate treatment and further management in patients with unstable CAD. The early symptom-limited ET together with specific biochemical marker determination is an inexpensive, widely applicable method for early risk stratification. In women, however, the ET is considered less reliable, and there are few data on biochemical markers for risk stratification in women.

METHODS

In a substudy of the Fragmin during InStability in Coronary artery disease (FRISC I) trial, 395 women and 778 men with unstable CAD who performed an early ET were followed for six months. Blood samples for TnT determination were taken in 342 women and 621 men at inclusion.

RESULTS

Based on the ET results, low-, intermediate-, and high-risk response groups were identified with event rates of cardiac death or myocardial infarction (MI) of 1%, 9%, and 19%, respectively, among women and 8%, 14%, and 20%, respectively, among men. Patients who could not perform the ET had an event rate similar to the high-risk group. The TnT levels were divided into three groups: <0.06, 0.06–0.19, and 0.20 µg/liter with event rates of 1%, 10%, and 18%, respectively, among women and 9%, 14%, and 18%, respectively, among men. Combining the ET results with TnT levels identified a low-risk group with an event rate of 3% in the male population and no events in the female population.

CONCLUSIONS

Direct comparison between men and women from the same population with a high pretest likelihood of disease suggests that both TnT and the early symptom-limited ET are at least as useful as prognostic risk indicators in women as they are in men.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CAD = coronary artery disease   ECG = electrocardiogram   ET = exercise test   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   TnT = troponin T

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