High-sensitivity cardiac troponin T and prognosis in patients with ST-segment elevation myocardial infarction. Issue 3 (September 2018)

• Record Type: Journal Article
• Authors: Ndrepepa, Gjin; Kufner, Sebastian; Hoyos, Magdalena; Harada, Yukinori; Xhepa, Erion; Hieber, Julia; Cassese, Salvatore; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan
• Is Part Of: Journal of cardiology. Volume 72:Issue 3(2018)
• Page Start: 220
• Page End: 226
• Publication Date: 2018-09
• Subjects: High-sensitivity cardiac troponin -- Mortality -- Prognosis -- ST-segment elevation myocardial infarction; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2018.02.014
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: Admission or postprocedural hs-cTnT predicts 3-year mortality after primary PCI. Admission or postprocedural hs-cTnT improves risk prediction for mortality. Hs-cTnT may be incorporated in risk prediction scores in patients with STEMI. Abstract: Background: Evidence on the use of high-sensitivity cardiac troponins (hs-cTn) to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI) is limited. Methods: We assessed the prognostic value of preprocedural (admission) and peak postprocedural hs-cTnT in 818 patients with STEMI treated with primary percutaneous coronary intervention (PPCI). Preprocedural and peak postprocedural hs-cTnT was measured. The primary outcome was 3-year all-cause mortality. Results: The median values of preprocedural and peak postprocedural hs-cTnT were 153 ng/L and 1980 ng/L. Overall, 134 patients died during the follow-up. There were 85 deaths in patients with preprocedural hs-cTnT >median value and 49 deaths in patients with preprocedural hs-cTnT ≤median value [Kaplan–Meier estimates of mortality, 22.2% and 13.5%; unadjusted hazard ratio (HR) = 1.88, 95% confidence interval (CI) 1.32–2.67, p < 0.001]. According to peak postprocedural hs-cTnT, there were 84 deaths in patients with postprocedural hs-cTnT >median value and 50 deaths in patients with postprocedural hs-cTnT ≤median value [Kaplan–Meier estimates of mortality, 22.3% and 13.4%; unadjusted HR = 1.82 (1.28–2.59), p < 0.001]. After adjustment, preprocedural [adjusted HR = 1.08 (1.03–1.12), p < 0.001] and peak postprocedural hs-cTnT value [adjusted HR = 1.06 (1.04–1.08), p < 0.001] were independently associated with 3-year mortality (with risk estimates calculated per 70 × 99th upper reference limit of hs-cTnT). The C statistic of multivariable model increased from 0.868 (0.841–0.895) to 0.872 (0.845–0.898) after incorporation of preprocedural hs-cTnT ( p = 0.050) and to 0.874 (0.846–0.899) after incorporation of the postprocedural hs-cTnT into the model ( p = 0.035). Conclusions: In conclusion, admission or peak postprocedural hs-cTnT is independently associated with the risk for 3-year mortality in patients with STEMI undergoing PPCI.