title: Risk stratification in patients with unstable angina using absolute serial changes of 3 high-sensitive troponin assays.
abstract: BACKGROUND
  It is unknown whether unstable angina (UA) results in previously nondetectable low-level myocardial necrosis. We compared the pattern of myocardial necrosis between patients with UA, acute myocardial infarction (AMI), and noncardiac chest pain (NCCP) using 3 high-sensitive cardiac troponin (hs-cTn) assays.
  
  
  METHODS
  In a multicenter study, we enrolled 842 unselected patients with acute chest pain in the emergency department. Roche hs-cTnT, Beckman Coulter hs-cTnI, and Siemens hs-cTnI were determined in a blinded fashion at presentation and after 1, 2, 3, and 6 hours. The final diagnosis was adjudicated by 2 independent cardiologists.
  
  
  RESULTS
  A change in hs-cTn of ≥2 ng/L within the first hour after presentation as assessed with Roche hs-cTnT, Beckman Coulter hs-cTnI, and Siemens hs-cTnI was observed in 26%, 31%, and 32% of patients with UA (n = 115) compared with 91%, 92%, and 96% in patients with AMI (n = 120) and 12%, 23%, and 16% in patients with NCCP (n = 415; P < .001 for all comparisons between UA and AMI, P > .05 for all comparisons between UA and NCCP). In patients with UA, such a 1-hour change in hs-cTn of ≥2 ng/L was associated with an increased risk of death or AMI during the 30-day follow-up (P = .003, .03, .03) and 2-year follow-up (P < .001, .002, and .006).
  
  
  CONCLUSIONS
  In marked contrast to patients with AMI, most patients with UA do not exhibit relevant hs-cTn changes. The minority of UA with hs-cTn changes, however, has a significantly worse short- and long-term outcome.
authors: Department of Cardiology, University Hospital Basel, Basel, Switzerland.
authors: Tobias
authors: T
authors: Reichlin
authors: Raphael
authors: R
authors: Twerenbold
authors: Claudia
authors: C
authors: Maushart
authors: Miriam
authors: M
authors: Reiter
authors: Berit
authors: B
authors: Moehring
authors: Nora
authors: N
authors: Schaub
authors: Cathrin
authors: C
authors: Balmelli
authors: Maria
authors: M
authors: Rubini Gimenez
authors: Rebeca
authors: R
authors: Hoeller
authors: Konstantin
authors: K
authors: Sakarikos
authors: Beatrice
authors: B
authors: Drexler
authors: Philip
authors: P
authors: Haaf
authors: Stefan
authors: S
authors: Osswald
authors: Christian
authors: C
authors: Mueller
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis*; D002637:Chest Pain / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D014336:Troponin / Q000032:analysis*
chemical_list: D014336:Troponin