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J Am Coll Cardiol, 2001; 38:979-986 © 2001 by the American College of Cardiology Foundation |
* Department of Cardiology, Uppsala, Sweden
Department of Clinical Chemistry, University Hospital, Uppsala, Sweden
Manuscript received February 5, 2001; revised manuscript received May 1, 2001, accepted June 25, 2001.
Reprint requests and correspondence: Dr. Bertil Lindahl, Department of Cardiology, University Hospital, S-751 85 Uppsala, Sweden
bertil.lindahl{at}card.uas.lul.se
OBJECTIVES
This study was designed to elucidate possible mechanisms for the prognostic value of troponin T (tnT).
BACKGROUND
The reasons for the adverse prognosis associated with elevation of troponins in unstable coronary artery disease are poorly understood.
METHODS
Patients enrolled in the Fast Revascularization during InStability in CAD (FRISC-II) trial were included. Clinical characteristics, findings at echocardiography and coronary angiography, and prognosis were evaluated in relation to different tnT levels.
RESULTS
Absence of significant coronary stenosis was more frequent and three-vessel disease or left main stem stenosis was less frequent in patients without, compared with, detectable tnT. The occurrence of visible thrombus increased with rising levels of tnT. In the group with the highest levels of tnT, occlusion of the left circumflex artery was more common than in the three other tnT groups, as was a left ventricular ejection fraction below 0.45. The one-year risk of death in the noninvasive arm of the study increased by increasing levels of tnT (1.6% to 4.6%), whereas the risk of myocardial infarction showed an inverted U-shaped curve and was lower in the lowest (5.5%) and highest (8.4%) tnT groups than in the two intermediate groups (17.5% and 16.2%).
CONCLUSIONS
Any detectable elevation of tnT raises the probability of significant coronary stenosis and thrombus formation and is associated with an increased risk of reinfarction and death. However, at a more pronounced elevation of troponin, a higher proportion of patients has a persistent occlusion of the culprit vessel and reduced left ventricular function, associated with a high mortality but a modest risk of reinfarction.
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