Key result
Elevated cTnI is linked to ~120% higher risk of thrombolysis failure in STEMI.
Why the study?
The role of circulating levels of cardiac troponin I and high-sensitivity C reactive protein on presentation in predicting intravenous thrombolysis outcome in STEMI patients was unclear.
Do high circulating levels of cTnI and hs-CRP on presentation predict failed intravenous thrombolysis and 30-day cardiac death in patients with STEMI?
Observational (n=786)
No
Do high circulating levels of cTnI and hs-CRP on presentation predict failed intravenous thrombolysis and 30-day cardiac death in patients with STEMI?
Relative Risk: 2.2 (95% CI 1.9–3.5)
p-value: p=<0.001
Elevated baseline levels of cTnI and hs-CRP in STEMI patients are strong, independent predictors of failed intravenous thrombolysis and increased 30-day cardiac mortality.
Elevated cTnI and hs-CRP levels were associated with thrombolysis failure and 30-day death; leaves open whether combined measurement improves early risk stratification in STEMI.
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), on presentation, in the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction (STEMI). DESIGN AND SETTING: Prospective observational study in a tertiary referral centre. PATIENTS: 786 consecutive patients with STEMI, who received intravenous thrombolysis in the first 6 h from index pain. MAIN OUTCOME MEASURES: The incidence of failed thrombolysis and of cardiac death by 30 days. Failed thrombolysis was defined as the absence of abrupt and sustained > or =50% ST-segment recovery in the first 90 min after the initiation of intravenous thrombolysis. RESULTS: The incidence of failed thrombolysis and 30-day cardiac death was 57.4% and 11.8%, respectively. By multivariate logistic regression analysis according to tertiles of both cTnI (RR, 1.5; 95% CI 1.1 to 1.8, p = 0.004 for highest vs middle third; 2.2, 1.9 to 3.5, p<0.001 for highest vs lowest third; 1.5, 1.2 to 1.8, p = 0.001 for middle vs lowest third) and hs-CRP (RR, 2.0, 95% CI, 1.6 to 2.2; p<0.001 for highest vs middle third; 2.6, 2.1 to 3.5, p<0.001 for highest vs lowest third; 1.3, 1.2 to 1.7, p = 0.02 for middle vs lowest third), were independently associated with failed thrombolysis. Moreover, by multivariate Cox regression analysis according to tertiles of both cTnI (HR 1.2, 95% CI 1.1 to 1.8, p = 0.03 for highest vs middle third; 1.5, 1.2 to 2.2, p = 0.004 for highest vs lowest third; 1.1, 0.6 to 1.4, p = 0.6 for middle vs lowest third) and hs-CRP (HR1.2, 95% CI 1.1 to 1.6, p = 0.04 for highest vs middle third; 1.7, 1.3 to 2.6, p = 0.001 for highest vs lowest third; 1.1, 0.9 to 2.1, p = 0.1 for middle vs lowest third), 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 received intravenous thrombolysis in the first 6 h of STEMI.
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Foussas et al. (2007) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=786). High circulating levels of cardiac troponin I (cTnI) and high-sensitivity C reactive protein (hs-CRP) vs. Lower circulating levels (tertiles) was evaluated on Failed thrombolysis (RR 2.2, 95% CI 1.9 to 3.5, p=<0.001). High levels of cTnI and hs-CRP independently predicted intravenous thrombolysis failure (cTnI highest vs lowest RR 2.2; 95% CI 1.9-3.5; p<0.001) and 30-day cardiac death in STEMI patients.
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