Elevated troponin T and C-reactive protein predict impaired outcome for 4 years in patients with refractory unstable angina, and troponin T predicts benefit of treatment with abciximab in combination with PTCA
AIMS: Treatment with the glycoprotein IIb/IIIa receptor antagonist abciximab before and during coronary intervention in refractory unstable angina improves early outcome. We collected 4-year follow-up data to assess whether this benefit is sustained. Additionally, we investigated the predictive value of baseline troponin T and CRP for long-term cardiovascular events. METHODS AND RESULTS: Of 1265 patients enrolled in the CAPTURE trial follow-up was available in 94% of the patients alive after 6 months (median 48 months). Survival was similar in both groups. Both elevated troponin T and CRP were associated with impaired outcome, independently of other established risk factors, but with a different time course. Elevated troponin was associated with increased procedure related risk, and elevated CRP with increased risk for subsequent events. Lower rates of the composite end-point of death or myocardial infarction with abciximab vs. placebo were sustained during long-term follow up: 15.7% vs 17.2% at 4 years (P=ns), particularly in patients with elevated troponin T: 16.9% with abciximab vs 28.4% with placebo: P=0.015. Elevated CRP was not associated with specific benefit of abciximab. CONCLUSION: Troponin T as a marker of thrombosis and CRP as a marker of inflammation are independent predictors of impaired outcome at 4 years follow-up. The initial benefit from abciximab with regard to death and myocardial infarction was preserved at 4 years. No specific benefit with abciximab was observed for patients with elevated CRP, suggesting that a chronic inflammatory process is not affected by abciximab. In contrast the benefit of treatment in patients with elevated troponin T implies that the acute thrombotic process in refractory unstable angina is treated effectively.
|Keywords||Angina, Unstable/blood/drug therapy/*therapy, Angioplasty, Transluminal, Percutaneous Coronary/*methods, Antibodies, Monoclonal/*therapeutic use, C-Reactive Protein/*metabolism, Chronic Disease, Combined Modality Therapy/methods, Female, Follow-Up Studies, Humans, Immunoglobulin Fab Fragments/*therapeutic use, Male, Middle aged, Platelet Aggregation Inhibitors/*therapeutic use, Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors, Predictive Value of Tests, Survival Analysis, Treatment Outcome, Troponin T/*metabolism|
Lenderink, T., Heeschen, C., Vahanian, A., de Boer, M.J., Umans, V.A.W.M., Hamm, C.W., … Boersma, H.. (2003). Elevated troponin T and C-reactive protein predict impaired outcome for 4 years in patients with refractory unstable angina, and troponin T predicts benefit of treatment with abciximab in combination with PTCA. European Heart Journal. Retrieved from http://hdl.handle.net/1765/10085