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.
- myocardial infarction
- percutaneous coronary intervention
Data availability statement
Data are available upon reasonable request.
Statistics from Altmetric.com
JC-L and GG are joint first authors.
KS and IS are joint senior authors.
Presented at Part of the research data shown in this manuscript was presented as a poster entitled 'The additive value of pre- and post-reperfusion cardiac troponin T levels in risk stratification of patients with ST-segment elevation myocardial infarction' at the European Society of Cardiology (ESC) Congress 2019.
Contributors JC-L and GG performed data analyses and interpretation and drafted the manuscript. JA, SERA, DG, FA and AJB performed data collection. CB, KS, LS, GR and AJB critically revised the manuscript for important intellectual content. KStellos, KStamatelopoulos and IS provided substantial contributions to the conception and design of the work and critically revised the manuscript. KS and IS are responsible for the overall content of the work as guarantors.
Funding JC-L is supported by a PhD scholarship (Ministry of Education of Brazil) and an academic development scholarship from Newcastle University. G.Georgiopoulos was supported by Onassis Foundation under the special grant & support program for scholar's association members (Grant No. R ZP 001/2019-2020). KStellos is supported by the European Research Council MODVASC grant. KSopova is supported by a scholarship from the German Heart Foundation (Deutsche Herzstiftung). IS is supported by the British Heart Foundation and Newcastle upon Tyne Hospitals NHS Charity.
Disclaimer The sponsors had no role in the study design, data collection and analysis, writing of the manuscript or in the decision to submit the manuscript for publication.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.