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Unstable angina represents a critical phase of ischaemic heart disease * Stratifyiug patients with unst:able angina for risk remains a difficult clinical problem * A new cardiac specific protein, troponin T, can now be measured in serum * The detection of troponin T 12-24 hours after admission identifies a high risk subgroup of patients with unstable angina * Prospective trials are required to identify optimum therapeutic strategies for this subgroup test, P = 0.004; relative risk 2.45 (1.30 to 4.61)) (fig 1).In the logistic regression model troponin T status was the most significant single variable predictor for this end point (P = 0.008; relative risk 2.55 (1.28 to 5.08)).Again the presence of either variable that is, accelerated angina or troponin T status-was highly significant for this end point (P = 0.0007) (table 2).Eighteen (29%) troponin T positive patients versus 21 (17%) troponin T negative patients either died or suffered a non-fatal myocardial infarction as a first event (fig 1) (log rank test, P = 0.07).This difference reached significance when allowance was made for coronary revascularisation by means of the Mantel-Haenszel statistic (P = 0.042; relative risk 2.16 (1.03 to 4.53)).In the logistic regression model patients with diabetes (table 2) had a significantly increased risk for this end point.The association with troponin T status did not reach significance (P = 0.12). CommentThe overall finding from this study is that, though it should not be used as a sole discriminator of future risk, a serum troponin T concentration ¢0.2 tg/l measured 12-24 hours after admission will identify a subgroup of patients with unstable angina in routine clinical practice who are at increased risk of cardiac events on long term follow up.Prospective randomised trials are required to identify optimum therapeutic strategies for this subgroup.