A combination of troponin T and 12-lead electrocardiography: a valuable tool for early prediction of long-term mortality in patients with chest pain without ST-segment elevation.

BACKGROUND: Electrocardiography (ECG) obtained on admission and a troponin T (tn-T) level measured early after admission are simple and accessible methods for predicting outcome in patients with suspected unstable angina or myocardial infarction without persistent ST-elevations. However, there are few studies about the combination of these 2 methods as a means of predicting long-term outcome.

METHODS: ECG was obtained on admission, and a tn-T level was analyzed on admission and after 6 hours in 710 consecutive patients admitted because of chest pain and no ST-elevations. Patients were observed for a median time of 40 months for death.

RESULTS: ST-segment depressions > or =0.05 mV were present in 266 patients (37%). These patients had a 9.7-fold increased risk of death, compared with patients with normal ECG results. Isolated T-Wave inversions or pathological signs other than ST-T changes were present in 196 patients (28%), who had a 4.5-fold increased risk of death compared with patients who had normal ECG results. At 6 hours after admission, 169 patients (24%) had at least 1 sample of tn-T > or =0.10 microg/L, which resulted in an 3.7-fold increased risk of death. In a multivariate analysis, both ECG on admission and tn-T level came out as independent predictors of outcome. When these methods were combined, patients could be divided into low- (tn-T level <0.10 microg/L and no ST-segment depression), intermediate- (tn-T level > or =0.10 microg/L or ST-segment depression), and high-risk groups (tn-T level > or =0.10 microg/L and ST-segment depression).

CONCLUSIONS: ECG and tn-T level are valuable tools to quickly risk stratify patients with chest pain. The combination of these methods is superior to either one alone.