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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
High-sensitivity cardiac troponin T and prognosis in patients with ST-segment elevation myocardial infarction
Gjin Ndrepepa1, Sebastian Kufner1, Magdalena Hoyos1
1Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
Insights
High-sensitivity cardiac troponin T (hs-cTnT) levels upon admission and after primary percutaneous coronary intervention (PPCI) independently predict 3-year mortality in ST-segment elevation myocardial infarction (STEMI) patients. This aids in risk stratification for better patient outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Medicine
Background:
- Limited evidence exists on using high-sensitivity cardiac troponins (hs-cTn) for risk stratification in ST-segment elevation myocardial infarction (STEMI).
- Accurate risk assessment is crucial for managing STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
Purpose of the Study:
- To evaluate the prognostic value of preprocedural (admission) and peak postprocedural hs-cTnT.
- To determine the association of hs-cTnT levels with 3-year all-cause mortality in STEMI patients treated with PPCI.
Main Methods:
- Prospective study of 818 STEMI patients treated with PPCI.
- Measurement of preprocedural and peak postprocedural hs-cTnT.
- Analysis of 3-year all-cause mortality using Kaplan-Meier and Cox regression models.
Main Results:
- Both preprocedural and peak postprocedural hs-cTnT levels were significantly associated with increased 3-year mortality.
- Higher hs-cTnT values (above median) correlated with substantially higher mortality rates.
- Multivariable analysis confirmed hs-cTnT as an independent predictor of mortality, improving risk model discrimination.
Conclusions:
- Admission and peak postprocedural hs-cTnT levels are independent predictors of 3-year mortality in STEMI patients undergoing PPCI.
- hs-cTnT measurements can enhance risk stratification strategies for STEMI patients.
- These findings support the routine use of hs-cTnT in STEMI management for prognostic assessment.
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 153ng/L and 1980ng/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.
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