Predictors of elevated cardiac troponin T on admission in ST-segment elevation myocardial infarction
Saman Rasoul1, Mark B Nienhuis, Jan Paul Ottervanger
1Isala Klinieken, Locatie Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Insights
Elevated cardiac troponin T (cTnT) in ST-segment elevation myocardial infarction (STEMI) is common, even with early treatment. Presentation delay, older age, and anterior MI location independently predict higher cTnT levels.
Area of Science:
- Cardiology
- Biomarkers
- Acute Myocardial Infarction
Background:
- Elevated cardiac troponin T (cTnT) in ST-segment elevation acute myocardial infarction (STEMI) correlates with adverse outcomes.
- Presentation delay is a suspected primary driver of elevated admission cTnT levels.
Purpose of the Study:
- To investigate presentation delay and other factors predicting elevated cTnT on admission in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- Cardiac troponin T (cTnT) was measured on arrival in 444 STEMI patients undergoing primary PCI.
- An elevated cTnT level was defined as > 0.05 microg/L.
Main Results:
- Nearly 50% of patients had elevated admission cTnT.
- Elevated cTnT was associated with less successful primary PCI and higher one-year mortality.
- Presentation delay, anterior myocardial infarction (MI) location, and older age were independent predictors of elevated admission cTnT.
Conclusions:
- A significant proportion of STEMI patients present with elevated cTnT, irrespective of presentation time.
- Early presentation does not preclude elevated cTnT levels.
- Presentation delay, increasing age, and anterior MI location are key independent predictors of elevated admission cTnT.
Background:
In patients with ST-segment elevation acute myocardial infarction (STEMI), elevated cardiac troponin T (cTnT) on admission is associated with poorer outcomes despite early reperfusion. Presentation delay is thought to be the most important factor for the elevation of cTnT on admission. We evaluated presentation delay and other potential predictors of elevated cTnT on admission in patients treated with primary percutaneous coronary interventions (PCI) for STEMI.
Methods:
CTnT was measured upon arrival in the PCI centre in 444 patients with acute STEMI. An elevated cTnT was defined as > 0.05 microg/L.
Results:
The mean age was 61.7 years and patients were admitted at a median of 155 min after symptom onset. Almost 50% had an elevated cTnT on admission. Patients with a positive cTnT on admission were less likely to have successful primary PCI (87 versus 93%, P=0.048) and had significantly higher rates of one-year mortality (4.9 versus 1.3%, P=0.031). There was a significant association between presentation delay and the prevalence of elevated admission cTnT, but even patients with early presentation (<120 min after symptom onset) still had a high prevalence of elevated cTnT (33%). After multivariate analysis, apart from presentation delay, anterior MI location and higher age were independent predictors of elevated cTnT on admission.
Conclusion:
In patients with STEMI, the prevalence of elevated cTnT on admission is high, even in patients with early presentation. Independent predictors of elevated cTnT on admission are presentation delay, increasing age and anterior MI location.
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