Troponin-T in unstable angina--a clinical and angiographic study.

OBJECTIVE: To examine the prognostic significance of Troponin-T in patients admitted with unstable angina and to study their angiographic morphology. DESIGN: Single centre, prospective study of in hospital events. SETTING: Intensive coronary care unit of a large municipal general hospital. SUBJECTS: 128 consecutive patients admitted with a diagnosis of unstable angina (Braunwald's classification). METHODS: Measurement of Troponin-T by qualitative assay at admission, coronary angiography between 5th to 7th day. MAIN OUTCOME MEASURES: In hospital adverse cardiac events--recurrent angina, new myocardial infarction or cardiac deaths. RESULTS: Fifty six (43.7%) patients had a positive test. The incidence of recurrent angina was significantly higher in the Trop-T positive group (57.1% vs 11.1%, p < 0.001). Six patients of this developed acute myocardial infarction subsequently whereas none of the patients in the Trop-T negative group developed acute MI (10.7% v/s 0%, p = 0.05). There were two deaths in the Trop-T positive group and none in the Trop-T negative group. 44 (78.5%) patients of the Trop-T positive group and 60 patients in the Trop-T negative group underwent coronary angiography. There was no significant difference in the incidence of single vessel disease (27.2% v/s 20%, p = NS) or multivessel disease (72.7% v/s 69.9%, p = ns). None of the patients with a positive Trop-T had normal coronary angiography whereas 6 patients in the Trop-T negative group had a normal coronary angiography (0% v/s 10%, p < 0.05). Patients with a positive troponin T test had a significantly higher incidence of type B lesions and a higher incidence of intracoronary thrombus. CONCLUSIONS: The in hospital outcome of Trop-T positive patients was significantly worse than patients with a negative test. Patients with a positive troponin T test had more complex coronary morphology and a higher incidence of intracoronary thrombus. We conclude that troponin-T can be used as a prognostic marker in patients with unstable angina.

Serum fibrinogen and C-reactive protein levels predict major adverse cardiac events in unstable angina.

The aim of this study was to ascertain the relationship of raised serum levels of fibrinogen and C-reactive protein at admission with in-hospital major adverse cardiac events in patients with unstable angina and to delineate their angiographic morphology. This single centre, prospective study consisted of 192 patients admitted in an intensive coronary care unit of a large municipal hospital with final diagnosis of unstable angina. The clinical endpoints were: in-hospital recurrent angina, new myocardial infarction or cardiac death. Patients with elevated levels of serum fibrinogen and C-reactive protein at admission showed a significantly higher incidence of an in-hospital recurrent major adverse cardiac event (p = 0.001). The mean levels of these markers were also significantly higher in patients with an in-hospital cardiac event as compared to patients with an uneventful hospital stay (p = 0.001). At angiographic evaluation, patients with type B and type C lesions and intracoronary thrombus had significantly higher levels of these markers as compared to patients with type A lesions (p = 0.001). It is concluded that in patients with unstable angina, elevated levels of serum fibrinogen and C-reactive protein at admission indicate an adverse in-hospital outcome and a more complex coronary morphology. The elevated levels of these easily measurable serum markers can therefore be useful in risk stratification of patients with unstable angina.