Can C reactive protein or troponins T and I predict outcome in patients with intractable unstable angina?
OBJECTIVE
To determine whether a single blood test for the measurement of C reactive protein, or troponin I or T concentrations could be used to stratify patients with intractable unstable angina awaiting transfer for coronary angiography by correlating these values with coronary anatomy and transient myocardial ischaemia.


METHODS
Prospective study.


METHODS
Tertiary cardiac unit.


METHODS
All patients admitted to their local hospital with ischaemic chest pain, uncontrolled by medical treatment, in whom acute myocardial infarction had been excluded by serial measurement of creatine kinase and lack of Q waves on ECG.


METHODS
Coronary angiography and ST segment monitoring for 24 hours.


METHODS
Concentrations of C reactive protein, troponins T and I, coronary anatomy, presence of transient myocardial ischaemia.


RESULTS
Median C reactive protein, troponin I, and troponin T concentrations were 17.1 mg/dl (4.8 to 203.9), 0.05 microgram/l (0 to 7.8), and 0.0 microgram/l (0 to 2.51), respectively. Seven patients (10%) had normal coronaries and 14, 20, and 31 had one, two, or three vessel coronary disease, respectively. Nineteen (26%) had transient myocardial ischaemia, 33 (46%) had complex lesion morphology, and six (8%) had intracoronary thrombus. Of the three markers, troponin T alone was higher in patients with multivessel disease (p < 0.05) and in those with transient myocardial ischaemia (p < 0.05), but there was no significant relation between C reactive protein, troponin T or I and lesion morphology or thrombus.


CONCLUSIONS
In patients transferred to a tertiary centre with intractable chest pain, C reactive protein and troponin I are not predictive of transient myocardial ischaemia or lesion morphology, both of which are surrogate markers of outcome. Troponin T is, however, raised in patients with multivessel disease or transient myocardial ischaemia. These serum protein assays cannot be used to stratify the risk of patients with unstable angina who are awaiting transfer to the tertiary centre.
Department of Cardiology, Royal Brompton Hospital, London, UK.
N P
NP
Curzen
D J
DJ
Patel
M
M
Kemp
J
J
Hooper
C J
CJ
Knight
D
D
Clarke
C
C
Wright
K M
KM
Fox
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D014336:Troponin / Q000097:blood*; D019210:Troponin I / Q000097:blood; D020107:Troponin T
D015415:Biomarkers; D014336:Troponin; D019210:Troponin I; D020107:Troponin T; D002097:C-Reactive Protein