Classification And Risk Stratification Of Patients With Acute Chest Pain Using A Low Discriminatory Level Of Cardiac Troponin T

Background: Cardiac troponins are the biochemical markers of choice for the evaluation of acute coronary syndromes (ACS). Using the first-generation test, most studies related adverse outcome to > 0.20 or 0.10 mug/l cardiac troponin T (cTnT) levels. With the highly sensitive and specific second- and third-generation assays, cTnT is undetectable in most healthy individuals.Hypothesis: We evaluated whether a lower cTnT level, within 24 h of admission, could indicate an increased risk of future complications.Methods: During 1998-1999, clinical data were collected in 260 patients with ACS. Cardiac troponin T was measured at arrival, and 4, 8, and 12-24 h thereafter. The maximum cTnT value was then used to assess, over a 15-month follow-up period, the cumulative risk of death or myocardial infarction (MI), as well as rates of events according to quartiles of cTnT values.Results: Patients with less than or equal to 0.03 mug/l cTnT levels had the lowest rate of adverse events and the best Kaplan-Meier event-free survival curve. Increasing cTnT levels were associated with stepwise increases in mortality rates and with a constant 10-fold increase in MI rates during follow-up.Conclusions: A low threshold cTnT elevation is recommended to assess the risk of ACS. All cTnT elevations > 0.03 mug/l predict a higher risk of MI during follow-up, whereas increasing values predict mortality in relation to the amount of elevation.