An investigation into the prognostic value of the cardiac marker troponin T in patients with suspected acute coronary syndrome without ST segment elevation

This study was set up to investigate the prognostic significance of different bands of troponin T in the diagnosis and management of patients presenting with suspected acute coronary syndrome without ST segment elevation. The study was a cohort study, set in a District General Hospital in the north west of England. The participants were 421 patients admitted with suspected acute coronary syndrome without ST segment elevation over a three-month period. Analysis was carried out depending on whether the level of troponin elevation was in a negative (< 0.03 µg/L), intermediate (0.03–0.1 µg/L) or positive (> 0.1 µg/L) band. The outcome was a composite of all-cause mortality or hospital admission due to non-fatal myocardial infarction at 30 days and 12 months.
Both intermediate and positive levels of elevated troponin increased the risk of all-cause mortality and non-fatal myocardial infarction at least two-fold, both at 30 days and 12 months (p<0.01). People over 50 were found to have a worse prognosis than younger patients at 12 months (p<0.05) but gender had no significant effect.
Patients with suspected acute coronary syndromes without ST segment elevation who have either intermediate or positive levels of troponin T show a substantial increase in adverse outcomes during short- and long-term follow-up. Further research is required on these bandings as new generations of troponin assays are developed with improved levels of precision.