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
- thrombolytic therapy
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