This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Galvani, M. Articles by Jaffe, A. S. Search for Related Content PubMed PubMed Citation Articles by Galvani, M. Articles by Jaffe, A. S.

(Circulation. 1997;95:2053-2059.)
© 1997 American Heart Association, Inc.

Articles

Prognostic Influence of Elevated Values of Cardiac Troponin I in Patients With Unstable Angina

Marcello Galvani, MD; Filippo Ottani, MD; Donatella Ferrini, MD; Jack H. Ladenson, PhD; Antonio Destro, MD; Daniele Baccos, MD; Franco Rusticali, MD; Allan S. Jaffe, MD

the Fondazione Cardiologica "Myriam Zito Sacco," Forlì (M.G., F.O., D.F., F.R.), Divisione di Cardiologia, Forlì (M.G., D.F., F.R.), Divisione di Cardiologia, Ravenna (F.O.), Divisione di Cardiologia, Rimini (A.D.), and Divisione di Cardiologia, Riccione (D.B.), Italy, and Washington University, St Louis, Mo (J.H.L., A.S.J.). Dr Jaffe is now at SUNY Health Science Center at Syracuse, NY.

Correspondence to Dr Marcello Galvani, Fondazione Cardiologica Myriam Zito Sacco, P.zza F.lli Ruffini, 6, 47100 Forlì, Italy. E-mail sacco{at}mbox.queen.it

Background Elevations of the MB isoform of creatine kinase (CK) and cardiac troponin T seem to confer an adverse prognosis in unstable angina. We examined whether this prognostic influence is also present for cardiac troponin I (cTnI), a new and even more specific marker of myocardial injury.

Methods and Results We studied 106 patients with the clinical diagnosis of unstable angina showing chest discomfort at rest within 48 hours of admission, ECG evidence of myocardial ischemia, and normal values of total CK over the initial 16 hours of observation. The primary end point was death or nonfatal myocardial infarction (MI) at 30 days; the secondary end point was the incidence of cardiac events at 1 year. Blood was drawn every 8 hours for 3 days. Thirteen patients were excluded because of increased CK-MB mass concentrations within 16 hours of admission (non–Q-wave MI) and 2 because of inadequate blood sampling. Of the remaining 91 patients, 22 had cTnI elevations on admission (n=7) or after 8 hours (n=15). At 30 days, no deaths (0%) and 4 MIs (5.8%) occurred in the 69 patients with normal cTnI compared with 2 deaths (9.1%) and 4 MIs (18.2%) in the 22 patients with elevated cTnI. The combined incidence of death and nonfatal MI was 5.8% and 27.3%, respectively (P=.02). At 1 year, only 68% of patients with elevated cTnI were free of cardiac events, compared with 90% of those without elevations (P=.01).

Conclusions These data indicate that cTnI is an important prognostic variable in patients with unstable angina. Elevations of cTnI predict an adverse short- and long-term prognosis.

Key Words: prognosis • angina • myocardial infarction