The Prognostic Value of Serum Troponin T in Unstable Angina

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Abstract
Hamm and colleagues (July 16 issue)1 demonstrate the value of troponin T determinations in patients with unstable angina but understate their value in the differential diagnosis of patients with ischemic heart disease. In a preliminary evaluation of the troponin T assay in 93 patients presenting with chest pain to the coronary care unit, we found that troponin T measurement had an overall diagnostic accuracy of 98.7 percent.2 We found at that time that troponin T levels were elevated in four patients with angina, and speculated that measurement of troponin T might predict the prognosis of patients with angina. We have subsequently studied 400 patients admitted with chest pain and have also found that troponin T is detectable in 20 percent of patients without myocardial infarction as diagnosed by conventional markers (serial measurement of creatine kinase and its MB isoenzyme) but with ischemic heart disease. A detectable level of troponin T was associated with a higher incidence of subsequent cardiac events (death or infarction). It has been suggested that the clinical history, electrocardiogram, and minor increases in the levels of cardiac enzymes can be used to predict risk.3 We suggest that troponin T measurement is more appropriate.