Assessing risk following ST-segment elevation myocardial infarction: cardiac troponin or cardiac magnetic resonance imaging?

This editorial refers to ‘Prognostic value of high sensitivity troponin T after ST-segment elevation myocardial infarction in the era of cardiac magnetic resonance imaging’, by T.L. Nguyen et al ., on page 164. Outcomes following ST-segment elevation myocardial infarction have improved substantially over the last 20 years.1,2 Despite this, adverse outcomes are not uncommon with 1 in 10 patients dead 1 year following myocardial infarction. Current guidelines recommend risk stratification of patients with myocardial infarction prior to discharge from hospital.3 This involves the use of validated tools such as the Global Registry of Acute Coronary Events (GRACE) or the Thrombolysis in Myocardial Infarction (TIMI) risk scores4,5 and an assessment of infarct size and left ventricular function. The GRACE score provides an estimate of mortality in hospital and at 6 months, with the assessment of cardiac function providing insight into longer-term outcomes. Nguyen et al. 6 evaluate the relationship between serum high-sensitivity cardiac troponin T concentration and long-term outcomes in patients with ST-segment elevation myocardial infarction. Two hundred and one patients underwent cardiac magnetic resonance imaging and serial testing with a high-sensitivity cardiac troponin T assay during the index admission. The patients were then followed-up for a median of 602 days with the primary outcome consisting of a composite of mortality, re-infarction, heart failure, stroke, or ventricular arrhythmia. The authors conclude that serum cardiac troponin T concentrations in the ‘plateau phase’, 48–72 h from the onset of symptoms, were associated with adverse cardiovascular outcomes independent of infarct size and … [↵][1]*Corresponding author. Tel: +44 131 242 6432, Fax: +44 131 242 6379, E-mail: anoop.shah{at}ed.ac.uk [1]: #xref-corresp-1-1