Prognostic significance of troponin-T and clinical variables in acute coronary syndrome

Objectives: Troponin T (TnT) is an independent predictor for short and long-term adverse cardiac event. We evaluated the prognostic significance of TnT in our patients and also tested the prognostic significance of other early available clinical risk indicators, after adjustment for TnT. Methods: We studied 255 consecutive patients admitted with the diagnosis of Unstable Angina (UA) and Non-ST-Segment elevation myocardial infarction (NSTEMI). All patients had a baseline TnT estimation at presentation and repeated twelve hours later, in case of an initial negative result. Follow-up was available in 233 patients (91%) with a mean duration of 13 ± 6 months. Results: By Kaplan Meier estimates; survival free of myocardial infarction was 92.8% in TnT- vs. 66.9% in TnT+ group (p = 0.001) at 18 months. By multivariate Cox- regression analysis, independent predictors of death and myocardial infarction (MI) were positive TnT (HR 2.96, 95% CI 1.34-6.56), increasing age (HR for one year increase 1.05, 95% CI 1.02-1.08), history of congestive heart failure (CHF) (HR 6.17, 95% CI 2.40-15.87) and peak CK (HR for one IU/L rise 1.00, 95% CI 1.00-1.001) Conclusion: Positive Troponin T in patients with UA/NSTEMI is a strong, independent risk predictor of future death and MI. In addition, history of CHF, peak CK and age were also associated with increased risk of death and MI. Conventional risk predictors like pulse rate, ST depression, gender and diabetes were not identified as independent risk predictors.