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Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Kardiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2004 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 25, no 2, 113-120 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: The prognostic value of admission troponin T (tnT) levels and the resolution of the ST-segment elevation in ST-elevation myocardial infarction (STEMI) is well established. However, the combination of these two early available markers for predicting risk has not been evaluated.

METHODS AND RESULTS: We evaluated 516 patients with fibrinolytic treated STEMI from the ASSENT-2 and ASSENT-PLUS studies, which had both admission tnT and ST-monitoring available. We used a prospectively defined cut-off value of tnT of 0.1microg/l. For ST-segment resolution, a cut-off of 50% measured after 60min was used. Both a tnT >/=0.1microg/l (n=116) and ST-segment resolution <50% (n=301) were related to higher one-year mortality, 13% vs 4% (P<0.001) and 8.4% vs 2.8% (P=0.009), respectively. In a multivariate analysis ST-segment resolution was and tnT showed a strong trend to be independently related to mortality. The combination of both further improved risk stratification. The one-year mortality in the group with elevation of tnT and without ST-segment resolution compared to the group without tnT elevation and with ST-segment resolution was 18.2% vs 2.8% (P<0.001).

CONCLUSIONS: Both tnT on admission and ST-segment resolution after 60min are strong predictors of one-year mortality. The combination of both gives additive early information about prognosis and further improves risk stratification.

Place, publisher, year, edition, pages
2004. Vol. 25, no 2, 113-120 p.
Keyword [en]
Acute myocardial infarction, Troponin T, Electrocardiography, Prognosis
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93678DOI: 10.1016/j.ehj.2003.10.025PubMedID: 14720527OAI: oai:DiVA.org:uu-93678DiVA: diva2:167227
Available from: 2005-11-03 Created: 2005-11-03 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Early Risk Stratification, Treatment and Outcome in ST-elevation Myocardial Infarction
Open this publication in new window or tab >>Early Risk Stratification, Treatment and Outcome in ST-elevation Myocardial Infarction
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

We evaluated, in patients with ST-elevation myocardial infarction (STEMI) treated with thrombolytics, admission Troponin T (tnT), ST-segment resolution and admission N-terminal pro-brain natriuretic peptide (NT-proBNP) for early risk stratification as well as time delays and outcome in real life patients according to prehospital or in-hospital thrombolytic treatment. Also, baseline characteristics, treatments and outcome in patients enrolled in the ASSENT-2 trial in Sweden and in patients not enrolled were evaluated.

TnT (n=881) and NT-proBNP (n=782) on admission and ST-resolution at 60 minutes (n=516) in patients from the ASSENT-2 and ASSENT-PLUS trials were analysed. Elevated levels of NT-proBNP and tnT on admission were both independently related to one-year mortality. However, when adding information on ST-resolution (</≥50%) 60 minutes after initiation of thrombolytic treatment, tnT no longer contributed independently to mortality prediction. High and low risk patients were best identified by a combination of NT-proBNP and ST-resolution at 60 minutes.

We investigated consecutive STEMI patients included in the RIKS-HIA registry between 2001 and 2004, if they were ambulance transported and had received prehospital (n=1690) or in-hospital (n=3685) thrombolytic treatment. Prehospital diagnosis and thrombolysis reduced the time to thrombolysis by almost one hour, were associated with better left ventricular function and fewer complications and reduced the adjusted one-year mortality by 30% compared with in-hospital thrombolysis.

Prospective data from the RIKS-HIA registry on STEMI patients treated with thrombolytics were linked to data on trial participants in the ASSENT-2 trial of thrombolytic agents and used for direct comparisons. Patients treated with thrombolytics and not enrolled in a clinical trial at trial hospitals (n=2048) had higher risk characteristics, more early complications and twice as high adjusted one-year mortality compared to those enrolled (n=729). One major reason for the difference in outcome appeared to be the selection of less critically ill patients to the trial.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 70 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 81
Keyword
Medicine, Acute myocardial infarction, Thrombolysis, Troponin, Electrocardiography, Natriuretic peptide, Prognosis, Prehospital thrombolysis, Treatment delay, Mortality, Registry, Clinical trial, Medicin
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:uu:diva-6050 (URN)91-554-6384-3 (ISBN)
Public defence
2005-11-25, Robergsalen, Ingång 40, Akademiska sjukhuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2005-11-03 Created: 2005-11-03 Last updated: 2013-06-20Bibliographically approved

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Björklund, ErikLindahl, BertilVenge, PerWallentin, Lars

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