Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease.

Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease.

MedLine Citation:	PMID: 11036119 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	BACKGROUND: In patients with unstable coronary artery disease, there is a relation between the short-term risk of death and blood levels of troponin T (a marker of myocardial damage) and C-reactive protein and fibrinogen (markers of inflammation). Using information obtained during an extension of the follow-up period in the Fragmin during Instability in Coronary Artery Disease trial, we evaluated the usefulness of troponin T, C-reactive protein, and fibrinogen levels and other indicators of risk as predictors of the long-term risk of death from cardiac causes. METHODS: Levels of C-reactive protein and fibrinogen at enrollment and the maximal level of troponin T during the first 24 hours after enrollment were analyzed in 917 patients included in a clinical trial of low-molecular-weight heparin in unstable coronary artery disease. The patients were followed for a mean of 37.0 months (range, 1.6 to 50.6). RESULTS: During follow-up, 1.2 percent of the 173 patients with maximal blood troponin T levels of less than 0.06 microg per liter died of cardiac causes, as compared with 8.7 percent of the 367 patients with levels of 0.06 to 0.59 microg per liter and 15.4 percent of the 377 patients with levels of at least 0.60 microg per liter (P=0.007 and P=0.001, respectively). The rates of death from cardiac causes were 5.7 percent among the 314 patients with blood C-reactive protein levels of less than 2 mg per liter, 7.8 percent among the 294 with levels of 2 to 10 mg per liter, and 16.5 percent among the 309 with levels of more than 10 mg per liter (P=0.29 and P=0.001, respectively). The rates of death from cardiac causes were 5.4 percent among the 314 patients with blood fibrinogen levels of less than 3.4 g per liter, 12.0 percent among the 300 with levels of 3.4 to 3.9 g per liter, and 12.9 percent among the 303 with levels of at least 4.0 g per liter (P=0.004 and P=0.69, respectively). In a multivariate analysis, levels of troponin T and C-reactive protein were independent predictors of the risk of death from cardiac causes. CONCLUSIONS: In unstable coronary artery disease, elevated levels of troponin T and C-reactive protein are strongly related to the long-term risk of death from cardiac causes. These markers are independent risk factors, and their effects are additive with respect to each other and other clinical indicators of risk.

Authors:	B Lindahl; H Toss; A Siegbahn; P Venge; L Wallentin
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Publication Detail:	Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Journal Detail:	Title: The New England journal of medicine Volume: 343 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 2000 Oct
Date Detail:	Created Date: 2000-10-19 Completed Date: 2000-10-19 Revised Date: 2006-11-15
Medline Journal Info:	Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES
Other Details:	Languages: eng Pagination: 1139-47 Citation Subset: AIM; IM
Affiliation:	Department of Cardiology, University of Uppsala, Sweden. bertil.lindahl@card.uas.lul.se
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MeSH Terms
Descriptor/Qualifier:	Age Factors Angina, Unstable / blood, mortality Biological Markers / blood C-Reactive Protein / analysis Coronary Disease / blood, mortality Female Fibrinogen / analysis* Follow-Up Studies Humans Inflammation / blood, complications, diagnosis Male Multivariate Analysis Myocardial Infarction / blood, etiology, mortality Risk Factors Troponin T / blood*
Chemical
Reg. No./Substance:	0/Biological Markers; 0/Troponin T; 9001-32-5/Fibrinogen; 9007-41-4/C-Reactive Protein
Comments/Corrections
Comment In:	N Engl J Med. 2000 Oct 19;343(16):1179-82 [PMID: 11036126 ] N Engl J Med. 2001 Mar 1;344(9):688-9 [PMID: 11229340 ]

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