The combination of a continuous 12-lead ECG and troponin T; a valuable tool for risk stratification during the first 6 hours in patients with chest pain and a non-diagnostic ECG.
OBJECTIVE
The aim was to examine the early prognostic value of a combination of a continuous 12-lead ECG and troponin T in patients with chest pain and an ECG non-diagnostic for acute myocardial infarction.


RESULTS
ST monitoring was performed and samples for analysis of troponin T were collected from admission for 12 h from 598 patients. After 6 h, the peak value of troponin T in 27% was > or = 0.10 microg.l(- 1), while 15% had had ST episodes, defined as transient ST deviations of at least 0.1 mV. Both a troponin T > or = 0.10 microg. l(-1) and ST episodes predicted worsening outcome. After 30 days, there were 6.8% and 1.4% (P<0.01) cardiac deaths or myocardial infarctions in the group with and without troponin T > or = 0.10 microg.l(-1), respectively. The corresponding event rates in patients with and without ST episodes were 10% and 1.6% (P<0.001). In a multivariate analysis both troponin T and ST episodes were independent predictors of cardiac death or myocardial infarction. When ST monitoring and troponin T status were combined, patients could be divided into low-, intermediate-, and high-risk groups.


CONCLUSIONS
A combination of continuous 12-lead monitoring and troponin T seems to be a valuable tool for risk stratification during the first 6 h in this population.
Jernberg
T
T
Department of Cardiology, Cardiothoracic Center, University Hospital, Uppsala, Sweden.
Lindahl
B
B
Wallentin
L
L
D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis* / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
D020107:Troponin T