Cardiovascular risk and therapeutic benefit of coronary interventions for patients with unstable angina according to the troponin T status

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Abstract
Aims Elevation of troponin T in patients with unstable angina is predictive of adverse outcomes. Since no advanced therapeutic concept for such high-risk patients has been established, we investigated cardiac risk prior to, during, and after coronary revascularization in patients with unstable angina stratified according to the troponin T status. Methods and Results Out of 351 patients with unstable angina, troponin was elevated for 36% of the patients as determined by qualitative bedside tests. The patients were followed during hospitalization and 30 days after discharge for incidence of death and myocardial infarction. In troponin-positive patients, clinical symptoms were more refractory to medical treatment than in troponin-negative patients (78% vs 44%;P=0·002). Although these patients were catheterized earlier (1·6 vs 3·4 days;P=0·005) and more frequently (95% vs 69%;PPP=0·001). Also the following coronary intervention was more complicated (death, myocardial infarction; 15·3% vs 4·8%;P=0·02). During the 30-day follow-up period, cardiac risk remained elevated for troponin-positive patients. Conclusions Troponin T rapid testing reliably identified high-risk patients with unstable angina. A higher event rate was observed prior to and particularly in association with the coronary intervention. Coronary revascularization did not abrogate the increased risk of troponin-positive patients during the 30-day follow-up.