Angiographic correlates of a positive troponin T test in patients with unstable angina

Objective: To study the angiographic correlates of cardiac troponin T (cTnT)-positive and -negative patients with unstable angina pectoris, Background: A positive cTnT test identifies a high-risk subgroup of unstable angina pectoris patients, Only the high-risk cTnT-positive patients seem to benefit from a more aggressive antithrombotic treatment regimen, The underlying coronary pathology in cTnT-positive and -negative patients that explains the predictive power of cTnT on prognosis and response to antithrombotic therapy is largely unknown, Methods: A total of 197 subsequently admitted patients with unstable angina pectoris underwent cTnT testing by a rapid bedside assay and early qualitative and quantitative angiography, Long-term follow-up was 12 months. Results: Patients with cTnT-positive tests revealed more critical stenoses of culprit lesions (p = .041), more severe reductions of thrombolysis in myocardial infarction flow grades (p < .037), a higher prevalence of intracoronary thrombus (p = .079), and a poorer left ventricular function (p = .047), The odds ratio of cTnT was 5.8 (p < .0001) for presence of thrombus, reduced thrombolysis in myocardial infarction flow, and/or critical stenosis (> 90%), and was 3.1 (p = .005) for presence of three-vessel disease, left main disease, and/or reduced left ventricular ejection fraction, Coronary bypass grafting was more frequently performed in the cTnT-positive group. However, event-free survival was not different in our cohort characterized by a high rate of percutaneous coronary interventions. Conclusions: A positive cTnT test in patients with unstable angina pectoris indicates presence of more severe coronary artery disease and poorer left ventricular function. This finding could explain the differences in short- and long-term outcome and treatment responses to antithrombotic regimens.