The FRISC experience with troponin T. Use as decision tool and comparison with other prognostic markers

Early prognostic evaluation is essential for the application of appropriate treatment and further management in the heterogeneous population with unstable coronary artery disease. Among the variety of prognostic indicators that have been suggested, biochemical markers of myocardial damage, especially the troponins, have gained increasing interest. The FRISC troponin T (TnT) substudy has validated and provided additional insights into the use of biochemical markers for prognostic evaluation. Nine hundred and seventy-eight patients were enrolled and followed for 5 months. An increase in the rate of cardiac death or myocardial infarction was seen during follow-up, with increasing levels of TnT. The TnT level separated low and high risk patients better than the conventional division of unstable angina and myocardial infarction. In the comparison with other early available risk indicators TnT was an independent risk indicator and gave additive prognostic information to both inclusion ECG and the result of a predischarge exercise test. TnT was superior to CK-MB for risk stratification, while TnT and troponin I showed comparable results. In patients with elevated TnT, treatment with dalteparin significantly decreased the risk for death or myocardial infarction compared to placebo, while there was no benefit from dalteparin in patients without Tn-T elevation. Based on the experiences of the FRISC study and the literature we suggest that the use of troponins should be included in the diagnostic and prognostic evaluation of patients with suspicion of unstable coronary artery disease.