The combination of a continuous 12-lead ECG and troponin T. A valuable tool for risk stratification during the first 6 hours in patients with chest pain and a non-diagnostic ECG

Abstract

Aims The aim was to examine the early prognostic value of a combination of a continuous 12-lead ECG and troponin T in patients with chest pain and an ECG non-diagnostic for acute myocardial infarction.

Methods and Results ST monitoring was performed and samples for analysis of troponin T were collected from admission for 12h from 598 patients. After 6h, the peak value of troponin T in 27% was ≥0·10μg.l⁻¹, while 15% had had ST episodes, defined as transient ST deviations of at least 0·1mV. Both a troponin T ≥0·10μg.l⁻¹and ST episodes predicted worsening outcome. After 30 days, there were 6·8% and 1·4% (P<0·01) cardiac deaths or myocardial infarctions in the group with and without troponin T ≥0·10μg.l⁻¹, respectively. The corresponding event rates in patients with and without ST episodes were 10% and 1·6% (P<0·001). In a multivariate analysis both troponin T and ST episodes were independent predictors of cardiac death or myocardial infarction. When ST monitoring and troponin T status were combined, patients could be divided into low-, intermediate-, and high-risk groups.

Conclusions A combination of continuous 12-lead monitoring and troponin T seems to be a valuable tool for risk stratification during the first 6h in this population.

ECG, ST-monitoring, troponin T, unstable angina, myocardial infarction, prognosis

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Correspondence: Tomas Jernberg, MD, Department of Cardiology, Cardiothoracic Center, University Hospital, 751 85 Uppsala, Sweden.