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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
  1. Stefanos G Foussas
  1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
    1. Michael N Zairis (zairis66{at}otenet.gr)
    1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
      1. Stamatis S Makrygiannis
      1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
        1. Stavros J Manousakis
        1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
          1. Filippos A Anastassiadis
          1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
            1. Charalambos S Apostolatos
            1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
              1. Nikolaos G Patsourakos
              1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
                1. Markos P Glyptis
                1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
                  1. Joseph K Papadopoulos
                  1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
                    1. Denis C Xenos
                    1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
                      1. Evdokia N Adamopoulou
                      1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
                        1. Christopher D Olympios
                        1. Cardiology Department, Tzanio Hospital, Piraeus, Greece
                          1. Spyros K Argyrakis
                          1. Cardiology Department, Tzanio Hospital, Piraeus, Greece

                            Abstract

                            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), upon presentation, in the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infraction (STEMI).

                            Design Prospective observational study.

                            Setting Tertiary referral center.

                            Patients 786 consecutive patients with STEMI, who received intravenous thrombolysis in the first 6 hours from index pain.

                            Main outcome measures The incidence of failed thrombolysis and 30-day cardiac death. Failed thrombolysis was defined as the absence of abrupt and sustained iÝ50% ST-segment recovery in the first 90 min after intravenous thrombolysis starting.

                            Results The incidence of failed thrombolysis and 30-day cardiac death was 57.4% and 11.8%, respectively. By multivariate logistic regression analysis, tertiles of both cTnI (relative risk (RR), 95% confidence interval (CI) 1.5, 1.1 to 1.8, p=0.004 for third vs second; 2.2, 1.9 to 3.5 for third vs first, p<0.001; 1.5, 1.2 to 1.8 for second vs first, p=0.001) and hs-CRP (RR, 95% CI 2, 1.6 to 2.2; p<0.001 for third vs second; 2.6, 2.1 to 3.5 for third vs first, p<0.001; 1.3, 1.2 to 1.7 for second vs first, p=0.02), were independently associated with failed thrombolysis. Moreover, by multivariate Cox regression analysis, tertiles of both cTnI (hazard ratio (HR), 95% CI 1.2, 1.1 to 1.8, p=0.03 for third vs second; 1.5, 1.2 to 2.2 for third vs first, p=0.004; 1.1, 0.6 to 1.4 for second vs first, p=0.6) and hs-CRP (HR, 95% CI 1.2, 1.1 to 1.6, p=0.04 for third vs second; 1.7, 1.3 to 2.6 for third vs first, p=0.001; 1.1, 0.9 to 2.1 for second vs first, p=0.1), 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 thrombolysed in the first 6 hours of STEMI.

                            • cardiac troponin I
                            • high sensitivity C reactive protein
                            • myocardial infarction
                            • prognosis
                            • thrombolytic therapy

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