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||C-reactive protein, Glycoprotein IIb/IIIa receptor antagonist, Long-term follow-up, Troponin T, Unstable angina pectoris|
|Persistent URL||dx.doi.org/10.1016/S0195-668X(02)00322-6, hdl.handle.net/1765/63074|
|Journal||European Heart Journal|
Lenderink, T, Boersma, H, Heeschen, C, Vahanian, A, de Boer, M.J, Umans, V.A.W.M, … Simoons, M.L. (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. In European Heart Journal (Vol. 24, pp. 77–85). doi:10.1016/S0195-668X(02)00322-6