Volume 11, Number 6, November-December 2004

An investigation into the prognostic value of the cardiac marker troponin T in patients with suspected acute coronary syndrome without ST segment elevation
Aidan Kirkpatrick, Michael Martin, Philip Lewis, Simon Capewell, Gary Cook, Georgios Lyratzopoulos

This study was set up to investigate the prognostic significance of different bands of troponin T in the diagnosis and management of patients presenting with suspected acute coronary syndrome without ST segment elevation. The study was a cohort study, set in a District General Hospital in the north west of England. The participants were 421 patients admitted with suspected acute coronary syndrome without ST segment elevation over a three-month period. Analysis was carried out depending on whether the level of troponin elevation was in a negative (< 0.03 µg/L), intermediate (0.03–0.1 µg/L) or positive (> 0.1 µg/L) band. The outcome was a composite of all-cause mortality or hospital admission due to non-fatal myocardial infarction at 30 days and 12 months.
Both intermediate and positive levels of elevated troponin increased the risk of all-cause mortality and non-fatal myocardial infarction at least two-fold, both at 30 days and 12 months (p<0.01). People over 50 were found to have a worse prognosis than younger patients at 12 months (p<0.05) but gender had no significant effect.
Patients with suspected acute coronary syndromes without ST segment elevation who have either intermediate or positive levels of troponin T show a substantial increase in adverse outcomes during short- and long-term follow-up. Further research is required on these bandings as new generations of troponin assays are developed with improved levels of precision.

Br J Cardiol 2004;11:AIC89-AIC92.

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