The significance of circulating levels of both cardiac troponin I and high-sensitivity C reactive protein for the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction

• Published in: Heart (British Cardiac Society) Vol. 93; no. 8; pp. 952 - 956
• Main Authors: Foussas, S G, Zairis, M N, Makrygiannis, S S, Manousakis, S J, Anastassiadis, F A, Apostolatos, C S, Patsourakos, N G, Glyptis, M P, Papadopoulos, J K, Xenos, D C, Adamopoulou, E N, Olympios, C D, Argyrakis, S K
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01-08-2007; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Acute Coronary Syndromes; Aged; Biological and medical sciences; Biomarkers; Biomarkers - blood; C reactive protein; C-Reactive Protein - analysis; cardiac troponin (I or T); Cardiology. Vascular system; Coronary heart disease; CRP; cTn (I or T); Electrocardiography; Enzymes; Female; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Heart; Heart attacks; high-sensitivity C reactive protein; Hospitals; hs-CRP; Humans; Logistic Models; Male; Medical imaging; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - blood; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Prognosis; Proportional Hazards Models; Prospective Studies; Proteins; ST-segment elevation myocardial infraction; STEMI; Streptokinase - therapeutic use; Thrombolytic Therapy; Treatment Failure; Trends; Troponin I - blood; Heart; High; Human; Myocardial infarction; Prognosis; Intravenous administration; Prediction; Cardiovascular disease; Patient; Myocardial disease; Fibrinolysis; Phlebology; ST elevation; Sensitivity; Troponin I; Heart disease; Evolution; Level; Circulatory system; Cardiology; Predictive factor; C reactive protein
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2005.084954

Objectives: To evaluate, using continuous 12-lead ECG ST-segment monitoring, the role of circulating levels of both cardiac troponin I (cTnI) and high-sensitivity C reactive protein (hs-CRP), on presentation, in the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction (STEMI). Design and setting: Prospective observational study in a tertiary referral centre. Patients: 786 consecutive patients with STEMI, who received intravenous thrombolysis in the first 6 h from index pain. Main outcome measures: The incidence of failed thrombolysis and of cardiac death by 30 days. Failed thrombolysis was defined as the absence of abrupt and sustained ⩾50% ST-segment recovery in the first 90 min after the initiation of intravenous thrombolysis. Results: The incidence of failed thrombolysis and 30-day cardiac death was 57.4% and 11.8%, respectively. By multivariate logistic regression analysis according to tertiles of both cTnI (RR, 1.5; 95% CI 1.1 to 1.8, p = 0.004 for highest vs middle third; 2.2, 1.9 to 3.5, p<0.001 for highest vs lowest third; 1.5, 1.2 to 1.8, p = 0.001 for middle vs lowest third) and hs-CRP (RR, 2.0, 95% CI, 1.6 to 2.2; p<0.001 for highest vs middle third; 2.6, 2.1 to 3.5, p<0.001 for highest vs lowest third; 1.3, 1.2 to 1.7, p = 0.02 for middle vs lowest third), were independently associated with failed thrombolysis. Moreover, by multivariate Cox regression analysis according to tertiles of both cTnI (HR 1.2, 95% CI 1.1 to 1.8, p = 0.03 for highest vs middle third; 1.5, 1.2 to 2.2, p = 0.004 for highest vs lowest third; 1.1, 0.6 to 1.4, p = 0.6 for middle vs lowest third) and hs-CRP (HR1.2, 95% CI 1.1 to 1.6, p = 0.04 for highest vs middle third; 1.7, 1.3 to 2.6, p = 0.001 for highest vs lowest third; 1.1, 0.9 to 2.1, p = 0.1 for middle vs lowest third), were independently related with an increased risk of 30-day cardiac death. Conclusions: High circulating levels of both cTnI and hs-CRP are related with an independent increased risk of intravenous thrombolysis failure and 30-day cardiac death in patients who received intravenous thrombolysis in the first 6 h of STEMI.