Prognostic value of admission high-sensitivity troponin in patients with ST-elevation myocardial infarction
Jose Coelho-Lima1, Georgios Georgiopoulos1,2,3, Javed Ahmed4
1Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Insights
Admission high-sensitivity cardiac troponin T (hs-cTnT) levels predict mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Post-reperfusion hs-cTnT levels did not show prognostic value.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Medicine
Background:
- High-sensitivity cardiac troponin T (hs-cTnT) is vital for diagnosing ST-segment elevation myocardial infarction (STEMI).
- Its prognostic value in risk stratification for STEMI patients undergoing primary percutaneous coronary intervention (PPCI) is not well-defined.
Purpose of the Study:
- To evaluate the prognostic significance of hs-cTnT measured at admission and 12 hours post-reperfusion.
- To determine if hs-cTnT improves risk stratification in STEMI patients treated with PPCI.
Main Methods:
- Retrospective observational study of 3113 STEMI patients treated with PPCI.
- hs-cTnT levels measured at admission and 12 hours post-PPCI.
- Mortality data collected via UK Office of National Statistics; endpoints were in-hospital and overall mortality.
Main Results:
- Admission hs-cTnT >515 ng/L independently predicted in-hospital and overall mortality.
- Admission hs-cTnT significantly improved risk reclassification for both in-hospital and overall mortality.
- 12-hour post-reperfusion hs-cTnT levels were not independently associated with mortality.
Conclusions:
- Admission hs-cTnT is a valuable predictor of mortality in STEMI patients undergoing PPCI.
- Routine 12-hour hs-cTnT measurements may not be cost-effective for risk stratification in this population.
- Findings support the prognostic utility of early hs-cTnT measurements in STEMI management.
Background And Aim:
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).
Methods:
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.
Results:
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.
Conclusion:
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.
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