title: Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Cardiology, University Hospital of Uppsala, Sweden. erik.bjorklund@akademiska.se
authors.forename: Erik
authors.initials: E
authors.lastname: Björklund
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.forename: Per
authors.initials: P
authors.lastname: Johanson
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Svensson
authors.forename: Per
authors.initials: P
authors.lastname: Venge
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Mikael
authors.initials: M
authors.lastname: Dellborg
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T