Angiographic correlates of a positive troponin T test in patients with unstable angina.

Abstract

OBJECTIVE:

To study the angiographic correlates of cardiac troponin T (cTnT)-positive and -negative patients with unstable angina pectoris.

BACKGROUND:

A positive cTnT test identifies a high-risk subgroup of unstable angina pectoris patients. Only the high-risk cTnT-positive patients seem to benefit from a more aggressive antithrombotic treatment regimen. The underlying coronary pathology in cTnT-positive and -negative patients that explains the predictive power of cTnT on prognosis and response to antithrombotic therapy is largely unknown.

METHODS:

A total of 197 subsequently admitted patients with unstable angina pectoris underwent cTnT testing by a rapid bedside assay and early qualitative and quantitative angiography. Long-term follow-up was 12 months.

RESULTS:

Patients with cTnT-positive tests revealed more critical stenoses of culprit lesions (p =.041), more severe reductions of thrombolysis in myocardial infarction flow grades (p <.037), a higher prevalence of intracoronary thrombus (p =.079), and a poorer left ventricular function (p =.047). The odds ratio of cTnT was 5.8 (p <.0001) for presence of thrombus, reduced thrombolysis in myocardial infarction flow, and/or critical stenosis (>90%), and was 3.1 (p =.005) for presence of three-vessel disease, left main disease, and/or reduced left ventricular ejection fraction. Coronary bypass grafting was more frequently performed in the cTnT-positive group. However, event-free survival was not different in our cohort characterized by a high rate of percutaneous coronary interventions.

CONCLUSIONS:

A positive cTnT test in patients with unstable angina pectoris indicates presence of more severe coronary artery disease and poorer left ventricular function. This finding could explain the differences in short- and long-term outcome and treatment responses to antithrombotic regimens.

• Authors: N Frey, A Dietz, V Kurowski, E Giannitsis, R Tölg, U Wiegand, G Richardt, H A Katus
• Journal: Critical care medicine (Crit Care Med) Vol. 29 Issue 6 Pg. 1130-6 (Jun 2001) ISSN: 0090-3493 [Print] United States
• PMID: 11395586 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Troponin T

Topics

• Aged
• Angina Pectoris (blood, diagnostic imaging)
• Chi-Square Distribution
• Coronary Angiography
• Electrocardiography
• Female
• Humans
• Logistic Models
• Male
• Risk Assessment
• Statistics, Nonparametric
• Survival Analysis
• Troponin T (blood)