Prognostic value of admission high-sensitivity troponin in patients with ST-elevation myocardial infarction

Although the diagnostic usefulness of high-sensitivity cardiac troponin T (hs-cTnT) is well established in ST-segment elevation myocardial infarction (STEMI), its prognostic relevance in risk stratification of patients with STEMI remains obscure. This study sought to determine the prognostic value o...

Full description

Saved in:

Bibliographic Details
Published in:	Heart (British Cardiac Society) Vol. 107; no. 23; p. 1881
Main Authors:	Coelho-Lima, Jose, Georgiopoulos, Georgios, Ahmed, Javed, Adil, Syeda E R, Gaskin, David, Bakogiannis, Constantinos, Sopova, Kateryna, Ahmed, Fareen, Ahmed, Haaris, Spray, Luke, Richardson, Gavin, Bagnall, Alan J, Stellos, Konstantinos, Stamatelopoulos, Kimon, Spyridopoulos, Ioakim
Format:	Journal Article
Language:	English
Published:	England 01-12-2021
Subjects:	Aged Biomarkers - blood England - epidemiology Female Follow-Up Studies Humans Male Middle Aged Percutaneous Coronary Intervention - methods Prognosis Retrospective Studies ST Elevation Myocardial Infarction - blood ST Elevation Myocardial Infarction - mortality ST Elevation Myocardial Infarction - surgery Survival Rate - trends Time Factors Troponin - blood England percutaneous coronary intervention biomarkers myocardial infarction
Online Access:	Get more information
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Although the diagnostic usefulness of high-sensitivity cardiac troponin T (hs-cTnT) is well established in ST-segment elevation myocardial infarction (STEMI), its prognostic relevance in risk stratification of patients with STEMI remains obscure. This study sought to determine the prognostic value of pre-reperfusion (admission) and post-reperfusion (12-hour) hs-cTnT in patients with STEMI treated with primary percutaneous coronary intervention (PPCI). Retrospective observational longitudinal study including consecutive patients with STEMI treated with PPCI at a university hospital in the northeast of England. hs-cTnT was measured at admission to the catheterisation laboratory and 12 hours after PPCI. Clinical, procedural and laboratory data were prospectively collected during patient hospitalisation (June 2010-December 2014). Mortality data were obtained from the UK Office of National Statistics. The study endpoints were in-hospital and overall mortality. A total of 3113 patients were included. Median follow-up was 53 months. Admission hs-cTnT >515 ng/L (fourth quartile) was independently associated with in-hospital mortality (HR=2.53 per highest to lower quartiles; 95% CI: 1.32 to 4.85; p=0.005) after multivariable adjustment for a clinical model of mortality prediction. Likewise, admission hs-cTnT >515 ng/L independently predicted overall mortality (HR=1.27 per highest to lower quartiles; 95% CI: 1.02 to 1.59; p=0.029). Admission hs-cTnT correctly reclassified risk for in-hospital death (net reclassification index (NRI)=0.588, p<0.001) and overall mortality (NRI=0.178, p=0.001). Conversely, 12-hour hs-cTnT was not independently associated with mortality. Admission, but not 12-hour post-reperfusion, hs-cTnT predicts mortality and improves risk stratification in the PPCI era. These results support a prognostic role for admission hs-cTnT while challenge the cost-effectiveness of routine 12-hour hs-cTnT measurements in patients with STEMI.
ISSN:	1468-201X
DOI:	10.1136/heartjnl-2021-319225