Predictors of elevated cardiac troponin T on admission in ST-segment elevation myocardial infarction.
BACKGROUND
In patients with ST-segment elevation acute myocardial infarction (STEMI), elevated cardiac troponin T (cTnT) on admission is associated with poorer outcomes despite early reperfusion. Presentation delay is thought to be the most important factor for the elevation of cTnT on admission. We evaluated presentation delay and other potential predictors of elevated cTnT on admission in patients treated with primary percutaneous coronary interventions (PCI) for STEMI.


METHODS
CTnT was measured upon arrival in the PCI centre in 444 patients with acute STEMI. An elevated cTnT was defined as > 0.05 microg/L.


RESULTS
The mean age was 61.7 years and patients were admitted at a median of 155 min after symptom onset. Almost 50% had an elevated cTnT on admission. Patients with a positive cTnT on admission were less likely to have successful primary PCI (87 versus 93%, P=0.048) and had significantly higher rates of one-year mortality (4.9 versus 1.3%, P=0.031). There was a significant association between presentation delay and the prevalence of elevated admission cTnT, but even patients with early presentation (<120 min after symptom onset) still had a high prevalence of elevated cTnT (33%). After multivariate analysis, apart from presentation delay, anterior MI location and higher age were independent predictors of elevated cTnT on admission.


CONCLUSIONS
In patients with STEMI, the prevalence of elevated cTnT on admission is high, even in patients with early presentation. Independent predictors of elevated cTnT on admission are presentation delay, increasing age and anterior MI location.
Rasoul
Saman
S
Isala Klinieken, Locatie Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
Nienhuis
Mark B
MB
Ottervanger
Jan Paul
JP
Slingerland
Robbert J
RJ
de Boer
Menko-Jan
MJ
Dambrink
Jan-Henk E
JH
Ernst
Nicolette M
NM
Hoorntje
Jan C A
JC
Gosselink
A T Marcel
AT
Suryapranata
Harry
H
Zijlstra
Felix
F
van 't Hof
Arnoud W J
AW
D000368:Aged; D002624:Chemistry, Clinical / Q000379:methods*; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D015425:Myocardial Reperfusion; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
D020107:Troponin T