Key result
High admission cTnI predicts death and HF in STEMI after PCI regardless of D2B time.
Why the study?
The prognostic implications of combined admission cTnI levels and D2B time on in-hospital and 1-year heart failure and mortality in STEMI patients undergoing primary PCI remained uncertain.
Do admission cTnI levels and door-to-balloon time predict in-hospital and 1-year clinical outcomes in STEMI patients undergoing primary PCI?
Cohort (n=1,485)
No
Do admission cTnI levels and door-to-balloon time predict in-hospital and 1-year clinical outcomes in STEMI patients undergoing primary PCI?
p-value: p=<0.05
High admission cTnI (≥3 ng/mL) is a strong, independent predictor of adverse in-hospital and 1-year outcomes in STEMI patients undergoing primary PCI, regardless of whether door-to-balloon time is ≤90 minutes.
High admission cTnI may identify higher-risk STEMI patients independent of D2B time; leaves open prospective validation before incorporation into risk models.
BACKGROUND: The prognostic implications of the admission cTnI level and D2B time combined on in-hospital and 1-year heart failure (HF) and mortality in STEMI patients undergoing a primary percutaneous coronary intervention (PCI) are remain uncertain. METHODS AND RESULTS: We divided the consecutive 1485 STEMI patients who underwent PCI from January 2015 to October 2019 at our hospital into three groups based on their admission cTnI levels: normal group (<0.1 ng/mL), middle group (0.1 to less than 3 ng/mL), and high group (≥3 ng/mL) and into two groups by their D2B times: >90 min (>90-D2B) and ≤90 min (≤90-D2B). During the in-hospital and 1-year follow-up periods, the incidence of composite clinical events increased significantly with the increase in the admission cTnI level (p < 0.05). In-hospital, the composite rate of death and HF events was significantly higher in the >90-D2B group compared to the ≤90-D2B group (p = 0.006), but its influence disappeared in the 1-year follow-up (p > 0.05). A multivariable logistic analysis revealed that, in the ≤90-D2B group, with the exception of the cTnI ≥3 ng/mL patients, the cTnI level had no effect on in-hospital or 1-year outcomes; in >90-D2B group, cTnI ≥3ng/mL increased outcomes in both periods. CONCLUSION: High cTnI levels (≥3 ng/mL) on admission are independent of the D2B time for predicting in-hospital and 1-year cardiac events in STEMI patients undergoing PCI.
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A 2022 study conducted a cohort in ST-Segment Elevation Myocardial Infarction (STEMI) (n=1,485). High admission cardiac troponin I (cTnI) level and door-to-balloon (D2B) time >90 min vs. Lower cTnI levels and D2B time ≤90 min was evaluated on In-hospital and 1-year composite of death and heart failure events (p=<0.05). High admission cTnI levels (≥3 ng/mL) independently predicted in-hospital and 1-year composite clinical events in STEMI patients undergoing PCI, regardless of door-to-balloon time.