Prognostic significance of admission cardiac troponin T in patients treated successfully with direct percutaneous interventions for acute ST-segment elevation myocardial infarction.

Abstract

BACKGROUND:

Cardiac troponin T (cTnT) elevations at admission indicate a high-risk subgroup of patients with acute ST-segment elevation myocardial infarction, possibly due to a higher failure rate of reperfusion therapies.

OBJECTIVE:

We sought to determine the predictive role of admission cTnT in patients with ST-segment elevation myocardial infarction undergoing successful direct percutaneous coronary intervention.

METHODS:

A total of 218 consecutive patients with ST-segment elevation myocardial infarction were enrolled. Patients were stratified according to admission cTnT and infarct location. They were followed prospectively for short-term and long-term outcomes. RESULTS A positive cTnT (47.7%) was associated with higher mortality rates at 30 days (14.4% vs. 3.5%, p = .003) and 12 months (17.3% vs. 4.4%, p =.007). cTnT allowed discrimination of patients at high and low risk for cardiac death at 30 days and 12 months among anterior (19.2% vs. 7.9%, p = .19, and 25% vs. 13.2%, p = .22, respectively) and, more impressively, among nonanterior acute myocardial infarction (9.6% vs. 1.3%, p = .04, and 11.5% vs. 1.3%, p = .017, respectively). In multivariate analysis, older age, anterior infarct location, and depressed left ventricular function were the most potent independent predictors of future risk. Among clinical variables available at admission, cTnT indicated independently a higher risk of cardiac death (odds ratio, 3.1 [1.07-9.01], p =.038). This increased risk associated with a positive cTnT was almost independent of time delays from onset of symptoms to admission (3.8 vs. 2.3 hrs in cTnT-positive vs. cTnT-negative patients, p <.001).

CONCLUSIONS:

Admission cTnT is a strong predictor of future cardiac risk in patients with ST-segment elevation myocardial infarction, despite successful restoration of Thrombolysis in Myocardial Infarction grade 3 coronary flow by direct percutaneous coronary intervention.

• Authors: Volkhard Kurowski, Franz Hartmann, Dirk P Killermann, Evangelos Giannitsis, Uwe K H Wiegand, Norbert Frey, Margit Müller-Bardorff, Gert Richardt, Hugo A Katus
• Journal: Critical care medicine (Crit Care Med) Vol. 30 Issue 10 Pg. 2229-35 (Oct 2002) ISSN: 0090-3493 [Print] United States
• PMID: 12394949 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Troponin T

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Biomarkers (blood)
• Coronary Angiography
• Electrocardiography
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (blood, diagnosis, mortality, therapy)
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Risk Factors
• Stents
• Troponin T (blood)