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Acute coronary syndrome

Prevalence
Clinical features
Differential diagnosis
Investigations
Therapy
Prevention
Prognosis
Prognosis

Patients are at increased risk of dying, having an MI or requiring revascularisation with:
  • elevated troponin T a b

Elevated troponin T increases the risk of an MI

Patient Prognostic factor Outcome CER RR 
(95% CI)
NNT
(95% CI)
unstable angina a Elevated troponin T
  independent
MI  
at 3 weeks
2.9% 14 
(3.4 to 58)

(1 to 14)

 Elevated troponin T increases the risks of requiring coronary revascularisation    

Patient Prognostic factor Outcome CER OR 
(95% CI)
NNT
(95% CI)
unstable angina a Elevated troponin T within 24 hours
  independent
coronary revascularisation 
  at 3 years
22% 3.18 
(1.37 to 7.37)

(2 to 17)

Elevated troponin increases the risk of dying or having cardiovascular complications

Patient Prognostic Factor Outcome CER OR
(95% CI)
NNF+
(95% CI)
chest pain suggestive of ischaemic heart disease b troponin I or T 2 mcg/l or more within 24 hours
independent
death or MI
at 7 months
5.9% 2.5
(2.0 to 3.1)
13
(10 to 19)
    death
at 7 months
1.6% 3.1
(2.3 to 4.1)
31
(22 to 50)

 

Expiry date: June 2003
Levels of Evidence used in grading these guides

Authors   CM   Ball , N   Shenker
Reviewer   I K   Jang
CAT Writers   N   Shenker , CJ   Wotton , CM   Ball , RS   Phillips