The significance of circulating levels of both cardiac troponin I and high-sensitivity C reactive protein for the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction.
OBJECTIVE
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).


METHODS
Prospective observational study in a tertiary referral centre.


METHODS
786 consecutive patients with STEMI, who received intravenous thrombolysis in the first 6 h from index pain.


METHODS
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.
Foussas
S G
SG
Department of Cardiology, 40 Acti Themistokleous Street, Piraeus 18537, Greece. zairis@hellasnet.gr.
Zairis
M N
MN
Makrygiannis
S S
SS
Manousakis
S J
SJ
Anastassiadis
F A
FA
Apostolatos
C S
CS
Patsourakos
N G
NG
Glyptis
M P
MP
Papadopoulos
J K
JK
Xenos
D C
DC
Adamopoulou
E N
EN
Olympios
C D
CD
Argyrakis
S K
SK
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D017211:Treatment Failure; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D005343:Fibrinolytic Agents; D019210:Troponin I; D002097:C-Reactive Protein; D013300:Streptokinase