Cardiac
troponin T (
TnT) is a new serological marker for use as a diagnostic tool for myocardial damage. A blinded prospective multicentre study representing 298 patients who on admission were suspected of acute
myocardial infarction (AMI) to the coronary care units of six Scandinavian hospitals was undertaken to assess the diagnostic performance and prognostic efficacy of a new cardiospecific
TnT immunoassay. We used a discriminator value of
TnT of 0.20 micrograms/l. One hundred and fifty-five patients (52%) had definite AMI, based on WHO criteria (all had peak S-
TnT values > or = 0.20 micrograms/l); 127 patients (43%) had ischaemic
heart disease (IHD) without AMI; and 16 patients (5%) had non-IHD (all had peak S-
TnT values < 0.20 micrograms/l). The 127 IHD-patients without definite AMI could be subdivided into a group of 44 patients with S-
TnT peak values > or = 0.20 micrograms/l, and a group of 83 patients with
TnT below this level. A follow-up study was able to define the clinical significance of these findings. The cumulative six months probability of suffering
cardiac death or AMI was significantly higher in the subgroup with increased
TnT values (14% (6/44)) as compared to the other subgroup (4% (3/83)) (Log-rank test, p = 0.025). The probability of
cardiac events was 15% for the patients with definite AMI. We conclude that increased
troponin T in serum can detect a subgroup of IHD-patients in whom AMI has been ruled out, but who still have a prognosis as serious as that of patients with definite AMI.