Serial and single time-point measurements of cardiac troponin T for prediction of clinical outcomes in patients with acute ST-segment elevation myocardial infarction.
BACKGROUND
Cardiac troponins are the preferred biomarkers to predict infarct size in patients (pts) after acute myocardial infarction (AMI). Less information is currently available to verify the prognostic value of such a biomarker surrogate.


METHODS
We included 82 pts with acute STEMI and compared all single time point and serial cardiac troponin T (cTnT) values (peak and area-under-the-curve) from admission until day 4 to predict future major adverse cardiac events (MACE).


RESULTS
Pts who had suffered any MACE during follow-up had higher cTnT values (median (25th/75th percentiles) on day 4 (3.16 microg/l (2.71/5.20) Vs. 2.1 microg/l (1.19/3.96), P=0.0304), and higher peak cTnT values (5.11 microg/l (3.31/9.47) Vs. 2.92 microg/l (1.81/5.63), P=0.0234). The likelihood to develop a composite of MACE was twofold higher in the intermediate cTnT tertile (1.66-3.04 microg/l, n=23), and in the upper cTnT tertile (3.35-20.68 microg/l, n=23) for cTnT on day 4. For cTnT peak the risk was 1.7-fold higher in the intermediate cTnT peak tertile (2.55-5.01 microg/l, n=28) and 2.4-fold in the upper cTnT peak tertile (5.11-18.93 microg/l, n=27). The optimal ROC cutoff for cTnT to predict the composite of MACE was 2.69 microg/l measured on day 4 and 2.85 microg/l for the cTnT peak.


CONCLUSIONS
A single measurement of cTnT after STEMI is an independent predictor for MACE, performs as effective as serial cTnT sampling and may be useful to assess future events.
Kurz
Kerstin
K
Abteilung Innere Medizin III, Medizinische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. kerstin.kurz@med.uni-heidelberg.de
Schild
Christian
C
Isfort
Peter
P
Katus
Hugo A
HA
Giannitsis
Evangelos
E
D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D009206:Myocardium / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012044:Regression Analysis; D015996:Survival Rate; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T