Key result
Admission high-sensitivity cardiac troponin T >515 ng/L was independently associated with an increased risk of in-hospital mortality (HR 2.53) compared to lower quartiles in STEMI patients.
Why the study?
Although the diagnostic usefulness of hs-cTnT is well established in STEMI, its prognostic relevance in risk stratification remains obscure.
Does admission high-sensitivity cardiac troponin T predict in-hospital and overall mortality in patients with STEMI treated with primary percutaneous coronary intervention?
Cohort (n=3,113)
No
Does admission high-sensitivity cardiac troponin T predict in-hospital and overall mortality in patients with STEMI treated with primary percutaneous coronary intervention?
Hazard Ratio: 2.53 (95% CI 1.32–4.85)
p-value: p=0.005
Admission hs-cTnT, but not 12-hour post-reperfusion hs-cTnT, independently predicts in-hospital and overall mortality in STEMI patients undergoing PPCI, improving risk stratification.
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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Coelho‐Lima et al. (2021) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=3,113). Admission high-sensitivity cardiac troponin T (hs-cTnT) > 515ng/L vs. Lower quartiles of admission hs-cTnT (≤ 515ng/L) was evaluated on In-hospital mortality (HR 2.53, 95% CI 1.32-4.85, p=0.005). Admission high-sensitivity cardiac troponin T >515 ng/L was independently associated with an increased risk of in-hospital mortality (HR 2.53) compared to lower quartiles in STEMI patients.
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