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Previous Volume 335:1342-1349 October 31, 1996 Number 18 Next

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ABSTRACT

Background In patients with acute coronary syndromes, it is desirable to identify a sensitive serum marker that is closely related to the degree of myocardial damage, provides prognostic information, and can be measured rapidly. We studied the prognostic value of cardiac troponin I levels in patients with unstable angina or non–Q-wave myocardial infarction.

Methods In a multicenter study, blood specimens from 1404 symptomatic patients were analyzed for cardiac troponin I, a serum marker not detected in the blood of healthy persons. The relation between mortality at 42 days and the level of cardiac troponin I in the specimen obtained on enrollment was determined both before and after adjustment for base-line characteristics.

Results The mortality rate at 42 days was significantly higher in the 573 patients with cardiac troponin I levels of at least 0.4 ng per milliliter (21 deaths, or 3.7 percent) than in the 831 patients with cardiac troponin I levels below 0.4 ng per milliliter (8 deaths, or 1.0 percent; P<0.001). There were statistically significant increases in mortality with increasing levels of cardiac troponin I ( P<0.001). Each increase of 1 ng per milliliter in the cardiac troponin I level was associated with a significant increase (P = 0.03) in the risk ratio for death after adjustment for the base-line characteristics that were independently predictive of mortality (ST-segment depression and age >65 years).

Conclusions In patients with acute coronary syndromes, cardiac troponin I levels provide useful prognostic information and permit the early identificati on of patients with an increased risk of death.

Source Information

From the Department of Medicine (E.M.A., C.H.M., C.P.C., E.B.) and the Clinical Laboratories (M.J.T., G.A.F., D.W.), Brigham and Women's Hospital, Boston; the Maryland Medical Research Institute, Baltimore (B.T., M.S.); and the University of British Columbia, Vancouver (A.Y.F., C.T.).

Address reprint requests to Dr. Antman at the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.

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