Angiographic correlates of a positive troponin T test in patients with unstable angina.
OBJECTIVE
To study the angiographic correlates of cardiac troponin T (cTnT)-positive and -negative patients with unstable angina pectoris.


BACKGROUND
A positive cTnT test identifies a high-risk subgroup of unstable angina pectoris patients. Only the high-risk cTnT-positive patients seem to benefit from a more aggressive antithrombotic treatment regimen. The underlying coronary pathology in cTnT-positive and -negative patients that explains the predictive power of cTnT on prognosis and response to antithrombotic therapy is largely unknown.


METHODS
A total of 197 subsequently admitted patients with unstable angina pectoris underwent cTnT testing by a rapid bedside assay and early qualitative and quantitative angiography. Long-term follow-up was 12 months.


RESULTS
Patients with cTnT-positive tests revealed more critical stenoses of culprit lesions (p =.041), more severe reductions of thrombolysis in myocardial infarction flow grades (p <.037), a higher prevalence of intracoronary thrombus (p =.079), and a poorer left ventricular function (p =.047). The odds ratio of cTnT was 5.8 (p <.0001) for presence of thrombus, reduced thrombolysis in myocardial infarction flow, and/or critical stenosis (>90%), and was 3.1 (p =.005) for presence of three-vessel disease, left main disease, and/or reduced left ventricular ejection fraction. Coronary bypass grafting was more frequently performed in the cTnT-positive group. However, event-free survival was not different in our cohort characterized by a high rate of percutaneous coronary interventions.


CONCLUSIONS
A positive cTnT test in patients with unstable angina pectoris indicates presence of more severe coronary artery disease and poorer left ventricular function. This finding could explain the differences in short- and long-term outcome and treatment responses to antithrombotic regimens.
Frey
N
N
Department of Internal Medicine II, Medical University of Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany.
Dietz
A
A
Kurowski
V
V
Giannitsis
E
E
Tölg
R
R
Wiegand
U
U
Richardt
G
G
Katus
H A
HA
D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D020107:Troponin T / Q000097:blood*
D020107:Troponin T