Ten-year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia

Gamma-glutamyl transferase levels in patients with acute ischemic stroke

Objective. The aim of this study was to investigate the relationship between gamma-glutamyl transferase (GGT) levels, cerebrovascular risk factors, and distribution of cerebral infarct areas in patients with acute ischemic stroke (AIS). Patients and Methods. Sixty patients with AIS and 44 controls who had not cerebrovascular disease were included in the study. The patients were divided into four groups according to the location of the infarct area and evaluated as for GGT levels and the presence of diabetes mellitus (DM), hypertension (HT), and hyperlipidemia (HL). Results. The frequency of DM, HT, and HL and gender distributions were similar. The mean GGT levels were significantly higher in patients with AIS and those with relatively larger areas of infarction (P < 0.05). Increased mean GGT levels were found in the subgroup with hypertension, higher LDL-cholesterol, and triglyceride levels among cases with AIS (P < 0.05). Conclusion. Higher GGT levels in AIS patients reinforce the relationship of GGT with inflammation and oxidative stress. The observation of higher GGT levels in patients with relatively larger areas of infarction is indicative of a positive correlation between increases in infarct areas and elevated GGT levels.

Serum levels of gamma-glutamyl transferase are associated with cardiovascular disease in obstructive sleep apnea syndrome

BACKGROUND AND OBJECTIVES

Obstructive sleep apnea syndrome (OSAS) significantly increases the risk of cardiovascular disease (CVD). Gamma-glutamyl transferase (GGT) is a new marker for predicting CVD. The aim of this study was to evaluate the relationship of serum GGT levels with cardiovascular event, severity of OSAS, and polysomnographic parameters in patients with OSAS.

DESIGN AND SETTINGS

This was a retrospective, cross-sectional study conducted between January 2011 and March 2013 (Gaziosmanpasa University, Faculty of Medicine, Tokat, Turkey).

METHODS

We performed a retrospective study. Patients were divided according to their apnea-hypopnea index (AHI) scores into OSAS negative (AHI < 5, Group 1), mild OSAS (AHI: 5-15, Group 2), moderate OSAS (AHI=15.30, Group 3), and severe OSAS (AHI > 30, Group 4) groups. The presence of heart failure, coronary artery disease, or arrhythmia was defined as CVD.

RESULTS

A total of 320 patients, with a mean age of 50.2 (10.8) years, were included in this study. There were 47, 68, 58, and 147 patients in Groups 1, 2, 3, and 4, respectively. Serum GGT levels were significantly different between groups (Group 1: 25.24 [14.95]; Group 2: 28.03 [11.92]; Group 3: 32.82 [18.18], and Group 4: 40.41 [31.90] mg/dL , P < .001). Besides, serum GGT levels were significantly correlated with AHI, oxygen desaturation index, and average and minimum O2 saturation values (P < .05). Serum GGT levels were significantly higher in patients with CVD compared with those without (P < .05). Multiple regression analysis demonstrated that independent predictors of CVD were serum GGT and low-density lipoprotein-cholesterol levels, age, and body mass index in patients with OSAS.

CONCLUSION

GGT level is an important predictor for CVD in patients with OSAS. The effectiveness of continuous positive airway pressure therapy on CVD and GGT levels should be investigated.

The prognostic role of gamma-glutamyltransferase activity in non-diabetic ST-elevation myocardial infarction

In patients with acute coronary syndrome, gamma-glutamyltransferase activity (GGT) proved to be an independent predictor of the development of major adverse cardiac events at early and long terms. No data are available on GGT in ST-elevation myocardial infarction (STEMI). We assessed, in 337 consecutive STEMI patients without previously known diabetes submitted to mechanical revascularization, the prognostic role of GGT for in-Intensive Cardiac Care Unit mortality, together with the relation(s) between GGT and acute glucose dysmetabolism (admission glycemia, peak glycemia, insulin resistance as indicated by the Homeostatic Model Assessment HOMA index). At logistic regression analysis, GGT was an independent predictor for in-ICU mortality (OR 1.01 (95% CI 1.003-1.013) p = 0.002), when adjusted for BMI and for major bleedings [(OR 1.005 (95% CI 1.001-1.009) p = 0.029]. At linear regression analyses, GGT was significantly correlated with admission glycemia (r = 0.172; p = 0.002), uric acid (r = 0.146; p = 0.011), insulin (r = 0.171; p = 0.002) and age (r = -0.129; p = 0.020). We document that in STEMI patients without previously known diabetes submitted to mechanical revascularization, GGT values are an independent predictor of early mortality. The significant correlation between GGT and acute glucose dysmetabolism (as indicated by admission glycemia and insulin-resistance) can account, at least in part, for the prognostic role of GGT.

The relationship of gamma-glutamyltransferase to aortic elastic properties in young patients with prehypertension

Some cross-sectional studies have demonstrated a positive association between serum gamma-glutamyltransferase (GGT) levels and blood pressure. Accordingly, we aimed to analyze serum GGT levels in patients with prehypertension and examine the relationship with aortic elasticity parameters. The study population consisted of 25 newly diagnosed prehypertensive individuals and 25 healthy control subjects. Aortic strain, distensibility index, and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry. Prehypertensive patients were detected to have significantly lower aortic distensibility and strain indexes compared to control subjects aortic distensibility. However, aortic stiffness index beta of the prehypertensive group was significantly higher compared to that of the control group (3.73 ± 1.41 vs. 2.97 ± 0.82, p = 0.02). The mean GGT levels were found to be higher in patients with prehypertension compared to those of controls (47.9 ± 15.9 U/L vs. 36.1 ± 9.4 U/L, p = 0.003). When multiple linear regression analysis was done to clarify the contributions of GGT to aortic elasticity adjusting for age, body mass index, uric acid, serum glucose, heart rate, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, and triglyceride, we observed that only serum GGT levels were significantly associated with aortic elasticity parameters (for aortic strain beta = -0.247, p < 0.001; for aortic distensibility beta = -0.108, p < 0.001; for stiffness index beta = 0.063, p < 0.001). Whatever the mechanism is, young patients with prehypertension have higher serum GGT levels compared to healthy control subjects. More importantly, increased GGT levels are independently associated with impaired aortic elasticity in patients with prehypertension.

Gamma-glutamyltransferase activity in human atherosclerotic plaques--biochemical similarities with the circulating enzyme

BACKGROUND AND PURPOSE

Serum gamma-glutamyltransferase (GGT) activity has been identified as a predictor of complications of atherosclerosis, with a prognostic value for cardiovascular diseases and stroke. Human atherosclerotic lesions contain active GGT, which can give rise to pro-oxidant molecular species; thus a direct contribution of GGT to atherosclerosis progression is conceivable. The relationship between plaque and serum GGT is however unclear.

METHODS AND RESULTS

Human carotid plaques obtained from 18 consecutive patients undergoing carotid endoarteriectomy were analyzed, of which 6 were used for anion exchange and gel filtration chromatography/western blot studies, 7 for beta-lipoprotein precipitation, and 5 for RNA extraction and determination of low molecular weight thiols. Mean GGT activity in crude plaque homogenates was 60.9+/-21.5 (S.D.) mU/g tissue. The characteristics of GGT activity were compared in plaque homogenates and in serum obtained from controls (healthy blood donors). The methods employed (anion exchange and gel chromatography, western blot) showed the presence in plaque homogenates of two distinct complexes containing GGT activity, one of which comparable with plasma LDL/GGT complexes. Accordingly, precipitation of beta-lipoproteins from plaque homogenates resulted in removal of GGT activity. RT-PCR indicated in plaques the presence of GGT mRNA transcribed from GGT-I gene. Analysis of plaque extracts also revealed the presence of enzyme product cysteinyl-glycine both as free and protein-bound form, confirming that GGT-dependent pro-oxidant reactions may occur within the plaque environment.

CONCLUSIONS

The results obtained suggest the presence in plaques of a serum-like GGT protein, indicating that a direct contribution of serum GGT to enzyme activity found within atherosclerotic lesions is possible. Data also indicate the occurrence of GGT-mediated redox reactions within plaque environment, which might influence plaque progression.

The relationship of gamma-glutamyltransferase to C-reactive protein and arterial stiffness

BACKGROUND AND AIMS

The relationships between gamma-glutamyltransferase (GGT), C-reactive protein (CRP), and arterial stiffness have not been fully investigated. The aim of this study was to clarify whether serum GGT is related to CRP and arterial stiffness estimated using brachial-ankle pulse wave velocity (baPWV).

METHODS AND RESULTS

The subjects were 3412 males and 854 females. GGT, CRP, baPWV, and conventional risk factors were evaluated. On multiple regression analysis, after adjustment for the conventional risk factors, log GGT was significantly associated with log CRP in male and female subjects (male subjects: beta=0.168, p<0.0001; female subjects: beta=0.098, p<0.05). After adjustment for the conventional risk factors, log GGT was significantly associated with PWV in male subjects (beta=0.060, p<0.0001), but in female subjects, no significant relationships were found after adjustment (beta=0.007, p=0.82).

CONCLUSION

These results suggest that GGT is independently associated with an increased level of CRP in both males and females. In addition, in males, GGT is related to an increased level of arterial stiffness.

Serum gamma-glutamyl transferase is associated with plasma total homocysteine in Japanese patients with type 2 diabetes

Serum gamma-glutamyl transferase (gamma-GT), a marker of oxidative stress, predicts morbidity and mortality from cardiovascular disease. Plasma total homocysteine (tHcy), a pro-oxidant and also an independent risk factor for cardiovascular disease, correlates with gamma-GT among some populations. It is not known whether tHcy correlates with gamma-GT among type 2 diabetic patients in whom oxidative stress is increased and implicated for the development of diabetic complications. In the present study, we analyzed the association between gamma-GT, tHcy and related vitamins cross-sectionally among patients with type 2 diabetes without overt nephropathy (age range 17-76 years; n = 110). In a univariate regression analysis model, gamma-GT (logarithm) was positively associated with tHcy (beta = 0.288, P = 0.002) but not with folate or vitamin B(12). The association between tHcy and gamma-GT (logarithm) remained significant in a multivariate analysis model including age, lifestyle factors, folate, vitamin B(12), creatinine, HbA(1c) and medical history (beta = 0.219, P = 0.027). These results suggest that tHcy generates oxidative stress among type 2 diabetic patients and may partly explain the reported association between gamma-GT and cardiovascular disease.

Gamma glutamyltransferase and long-term survival: is it just the liver?

BACKGROUND

Increased gamma glutamyltransferase (GGT) is associated with cardiovascular disease. To date, however, few studies with sufficient sample size and follow-up have investigated the association of GGT with all-cause mortality.

METHODS

The relation of GGT to the risk of death was examined in a cohort of 283 438 first attendants (inpatients or outpatients) of the Vienna General Hospital with request for GGT analysis as part of a routine screening panel and was monitored for up to 13 years. To evaluate GGT as a predictor, Cox proportional hazards models were calculated, which were adjusted for age and sex.

RESULTS

In both men and women, GGT above the reference category (GGT > or = 9 U/L in women, > or = 14 U/L in men) was significantly (P <0.001) associated with all-cause, cancer, hepatobiliary, and vascular mortalities. Hazard ratios (HRs) for men and women were similar in all categories. Among patients who presented with GGT above the reference category, those younger than 30 years had higher all-cause mortality rates than did older individuals (HR 1.5-3.3 vs HR 1-1.3 >80 years, respectively).

CONCLUSIONS

GGT is associated with mortality in both men and women, especially in patients younger than 30 years, and even high-normal GGT is a risk factor for all-cause mortality.

Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study

OBJECTIVE

To determine whether serum gamma-glutamyl transferase (GGT) predicts cardiovascular disease (CVD) morbidity and mortality, accounting for temporal changes in known CVD risk factors and C-reactive protein (CRP).

METHODS AND RESULTS

In 3451 Framingham Study participants (mean age 44 years, 52% women) we examined the relations of GGT with CVD risk factors, and prospectively determined the risk of new-onset metabolic syndrome, incident CVD, and death. GGT was positively associated with body mass index, blood pressure, LDL cholesterol, triglycerides, and blood glucose in cross-sectional analysis (P<0.005). On follow-up (mean 19 years), 968 participants developed metabolic syndrome, 535 developed incident CVD, and 362 died. The risk of metabolic syndrome increased with higher GGT (multivariable-adjusted hazard ratio [HR] per SD increment log-GGT, 1.26 [95%CI; 1.18 to 1.35]). Adjusting for established CVD risk factors (as time-dependent covariates updated quadriennially) and baseline CRP, a 1-SD increase in log-GGT conferred a 13% increase in CVD risk (P=0.007) and 26% increased risk of death (P<0.001). Individuals in the highest GGT quartile experienced a 67% increase in CVD incidence (multivariable-adjusted HR 1.67, 95%CI; 1.25 to 2.22).

CONCLUSIONS

An increase in serum GGT predicts onset of metabolic syndrome, incident CVD, and death suggesting that GGT is a marker of metabolic and cardiovascular risk.

Serum gamma-glutamyltransferase is a predictor of incident coronary events in apparently healthy men from the general population

OBJECTIVE

To investigate whether serum gamma-glutamyltransferase (GGT) is an independent predictor for incident coronary events in initially healthy men from the general population.

METHODS AND RESULTS

The study was based on 1878 men (aged 25-64 years) who participated in the first MONICA Augsburg survey 1984/1985, and who were free of coronary heart disease at baseline. Up to 2002 a total of 150 incident acute coronary events occurred. Baseline levels of GGT were higher in men who experienced an event than in event-free men (28.4+/-2.0 units/l versus 22.4+/-2.1 units/l, p 0.0002). GGT was highly correlated with other cardiovascular risk factors. In a Cox proportional hazards model after age adjustment hazard ratios (HR) for incident myocardial infarction across GGT quartiles (<13, 13 to <20, 20 to <35, and >/=35 units/l) were 1.0, 1.84, 2.02, and 3.08 (p for trend 0.0001). Further adjustment for hypertension, TC/HDL ratio, diabetes, smoking, physical activity, alcohol intake, education years and BMI attenuated the association; comparing the highest versus lowest quartile of GGT the HR for a first-ever coronary event was then 2.34 (95% CI, 1.23-4.44).

CONCLUSIONS

Serum GGT is a strong predictor of acute coronary events in apparently healthy men from the general population, independent of other risk factors for cardiovascular disease.

Biological aging and Cox hazard analysis of mortality trends in a Mennonite community from south-central Kansas

This study investigated mortality in 568 individuals from the Goessel Mennonite community in rural central Kansas. There were three main objectives to this research: 1) characterize mortality trends within a biologically well-defined Mennonite community; 2) determine what biochemical, morphological, and physiological risk factors could be related to all-cause mortality, stratified by age and sex; and 3) compare these results to previously described variables that were associated with both biological age and mortality in this population. Mortality data were obtained from three sources: Kansas Vital Records, the Social Security death index, and church records. In total, 221 (39%) individuals were found to have died in this population between January 1980-June 2002. Analogous to the larger US population, the three leading causes of death in this community were heart disease, cancer, and stroke, accounting for 60% of all deaths. Besides advancing age, the greatest biological risk factor in this population was decreased amounts of albumin in men (relative risk, 2.47), potentially indicating underreported cases of either chronic kidney disease or frailty syndrome for males. Cox proportional hazard models demonstrated that increased amounts of total cholesterol may provide a protective effect for elderly individuals. We conclude, based on the previously described heritability of both albumin (h(2) = 0.40) and total cholesterol (h(2) = 0.50) in this population, that underlying genetic factors associated with both chronic degenerative diseases and biological aging may have important implications for understanding mortality patterns in this community.

Gamma-glutamyl transferase and airflow obstruction in middle-aged men

BACKGROUND

A relationship between pulmonary dysfunction and cardiovascular mortality has been described. The mechanism responsible for the relationship remains largely unknown.

METHODS

The association between airflow obstruction and selected cardiovascular risk factors including gamma-glutamyl transferase (gamma-GT) and total homocysteine was analyzed cross-sectionally in 954 middle-aged men. Airflow obstruction was assessed with %FEV(1) (FEV(1)/FVC).

RESULTS

Serum gamma-GT and white blood cell (WBC) count were higher in subjects with airflow obstruction (%FEV(1)<70%) than in those without it (76.9+/-164.3 IU/L vs. 55.9+/-67.9 IU/L, P=0.030; 6290+/-1590/microL vs. 5590+/-1410/microL, P<0.001). Airflow obstruction was not associated with body mass index, total cholesterol, triglycerides, fasting glucose, or systolic blood pressure, but there was a marginal association with total homocysteine. In a logistic regression analysis adjusted for smoking status and alcohol consumption, the odds ratios (95% confidence interval) of Delta100 IU/L increase in gamma-GT and Delta1000/microL increase in WBC count for the presence of airflow obstruction were 1.20 (0.97-1.48, P=0.090) and 1.21 (1.02-1.44, P=0.036), respectively.

CONCLUSIONS

Airflow obstruction was associated with gamma-GT. The association was independent of alcohol consumption category, but was attenuated by the addition of cigarette smoking status.

Gamma-glutamyl transferase and metabolic risk factors for cardiovascular disease

OBJECTIVE

To elucidate the mechanism of the reported association between serum gamma-glutamyl transferase (GGT) activity and cardiovascular mortality.

METHODS

Cross-sectional analysis of the relationship between serum GGT activity and the risk factors for cardiovascular disease was performed.

PATIENTS AND MATERIALS

Middle-aged Japanese male personnel of the Self-Defense Forces who underwent retirement check-up.

RESULTS

Serum GGT activity was associated with total cholesterol, triglyceride, fasting plasma glucose, total homocysteine and systolic blood pressure. The association remained in the analysis adjusted for possible confounders including cigarette smoking, ethanol consumption and body mass index.

CONCLUSION

The observed association between serum GGT and cardiovascular risk factors may partly explain the reported relationship between serum GGT activity and cardiovascular disease. Serum GGT activity may be regarded as a marker of cardiovascular risk factors or oxidative stress rather than a mere indicator of excessive ethanol consumption or obesity.

The significance of serum gamma-glutamyltransferase in cardiovascular diseases

Since early after the introduction of serum gamma-glutamyltransferase (GGT) in clinical practice as a reliable and widely employed laboratory test, epidemiological and prospective studies have repeatedly shown that this activity possesses a prognostic value for morbidity and mortality. The association is independent of possibly concomitant conditions of liver disease, and notably, a significant independent correlation of serum GGT exists with the occurrence of cardiovascular diseases (myocardial infarction, stroke). Experimental work has documented that active GGT is present in atherosclerotic plaques of coronary as well as in cerebral arteries. These findings, and the recently recognized functions of GGT in the generation of reactive oxygen species, indicate that serum GGT represents a true marker of cardiovascular diseases and underlying atherosclerosis. Further insights into potential therapeutic interest will probably be derived from studies investigating the origin of GGT activity in plaque tissue.

Serum gamma-glutamyltransferase and development of impaired fasting glucose or type 2 diabetes in middle-aged Japanese men

OBJECTIVE

To investigate the association between serum gamma-glutamyltransferase (GGT) and risk for development of diabetes.

DESIGN

Longitudinal study (followed from 1994 to 2001).

SETTING

A work site in Japan.

SUBJECTS

A total of 2918 Japanese male office workers aged 35-59 years who did not have impaired fasting glucose (IFG) (a fasting plasma glucose concentration of 6.1-6.9 mmol L-1), type 2 diabetes (a fasting plasma glucose concentration of >/=7.0 mmol L-1 or receipt of hypoglycaemic medication), medication for hypertension or hepatitis, alanine aminotransferase concentrations higher than three times the upper limit of the reference range or a history of cardiovascular disease at study entry.

MAIN OUTCOME MEASURE

Incidence of IFG or type 2 diabetes over a 7-year period.

RESULTS

With adjustment for potential risk factors for diabetes, the relative risk for IFG compared with serum GGT <16 U L-1 was 1.23 (95% CI, 0.79-1.90), 1.50 (CI, 0.97-2.32) and 1.70 (CI, 1.07-2.71) with serum GGT of 16-24, 25-43 and >/=44 U L-1, respectively (P for trend = 0.014). The respective relative risks for type 2 diabetes compared with serum GGT <16 U L-1 were 2.54 (CI, 1.29-5.01), 2.64 (CI, 1.33-5.23) and 3.44 (CI, 1.69-6.70) (P for trend = 0.002). From stratified analyses by body mass index (BMI) and alcohol intake, a stronger linear association between serum GGT and development of IFG or type 2 diabetes was found in men with a BMI >/=23.2 kg m-2 in both those who drank <46 and >/=46 g day-1 of ethanol.

CONCLUSIONS

The risk for development of IFG or type 2 diabetes increased in a dose-dependent manner as serum GGT increased in middle-aged Japanese men. The increased relative risk for IFG or type 2 diabetes associated with serum GGT was more pronounced in obese men.

Genetic Covariation between Serum γ-Glutamyltransferase Activity and Cardiovascular Risk Factors

Background: Several studies have shown that variation in serum γ-glutamyltransferase (GGT) in the population is associated with risk of death or development of cardiovascular disease, type 2 diabetes, stroke, or hypertension. This association is only partly explained by associations between GGT and recognized risk factors. Our aim was to estimate the relative importance of genetic and environmental sources of variation in GGT as well as genetic and environmental sources of covariation between GGT and other liver enzymes and markers of cardiovascular risk in adult twin pairs.

Methods: We recruited 1134 men and 2241 women through the Australian Twin Registry. Data were collected through mailed questionnaires, telephone interviews, and by analysis of blood samples. Sources of variation in GGT, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) and of covariation between GGT and cardiovascular risk factors were assessed by maximum-likelihood model-fitting.

Results: Serum GGT, ALT, and AST were affected by additive genetic and nonshared environmental factors, with heritabilities estimated at 0.52, 0.48, and 0.32, respectively. One-half of the genetic variance in GGT was shared with ALT, AST, or both. There were highly significant correlations between GGT and body mass index; serum lipids, lipoproteins, glucose, and insulin; and blood pressure. These correlations were more attributable to genes that affect both GGT and known cardiovascular risk factors than to environmental factors.

Conclusions: Variation in serum enzymes that reflect liver function showed significant genetic effects, and there was evidence that both genetic and environmental factors that affect these enzymes can also affect cardiovascular risk.

Gamma glutamyl transferase

Serum gamma-glutamyl transferase (GGT) has been widely used as an index of liver dysfunction and marker of alcohol intake. The last few years have seen improvements in these areas and advances in understanding of its physiological role in counteracting oxidative stress by breaking down extracellular glutathione and making its component amino acids available to the cells. Conditions that increase serum GGT, such as obstructive liver disease, high alcohol consumption, and use of enzyme-inducing drugs, lead to increased free radical production and the threat of glutathione depletion. However, the products of the GGT reaction may themselves lead to increased free radical production, particularly in the presence of iron. There have also been important advances in the definition of the associations between serum GGT and risk of coronary heart disease, Type 2 diabetes, and stroke. People with high serum GGT have higher mortality, partly because of the association between GGT and other risk factors and partly because GGT is an independent predictor of risk. This review aims to summarize the knowledge about GGT's clinical applications, to present information on its physiological roles, consider the results of epidemiological studies, and assess how far these separate areas can be combined into an integrated view.

Which factors determine the long-term outcome among patients with a very small or unconfirmed AMI

AIM

To describe various factors associated with the very long-term prognosis for patients with a very small or an unconfirmed acute myocardial infarction (AMI).

METHODS

Patients below 76 years of age, hospitalized due to suspected AMI who either developed a very small AMI (enzyme elevation<twice upper normal limit and maximum serum (S) aspartate aminotransferase (S-ASAT)<1.4 ukat/l) or an unconfirmed AMI (a suspected ischemic event with no signs of myocardial necrosis) were evaluated at our out-patient clinic. The 10-year mortality was related to the clinical history, age and sex, metabolic factors, diagnosis at hospital discharge, various psychosocial factors, use of medication, current symptoms, underlying reason to the symptoms, maximal working capacity and other observations at bicycle exercise test including signs of myocardial ischemia.

RESULTS

In all, 714 patients (33% women) with a median age of 63 years were included in the analyses. The following appeared as independent risk indicators for 10-year mortality: S-gammaglutamyl transpeptidase (GT) (P<0.0001), age (P<0.0001), current smoking (P<0.0001), a history of previous AMI (P<0.0001), maximal working capacity at bicycle exercise test (P=0.002), and current treatment with digitalis (borderline significance; P=0.022).

CONCLUSION

Among patients with a suspected acute myocardial ischemic event with no or minimal myocardial necrosis, various factors reflecting their age, history of cardiac disease and smoking, liver function, working capacity and possibly use of medication affected their very long-term prognosis.