title: High-sensitivity troponin level pre-catheterization predicts adverse cardiovascular outcomes after primary angioplasty for ST-elevation myocardial infarction.
abstract: BACKGROUND
  Cardiac troponins are the preferred biomarkers for diagnosing myocardial infarction (MI). High-sensitivity troponin T (hs-TnT) assays have increased sensitivity and enable more rapid diagnosis of infarction. We assessed the prognostic utility of admission hs-TnT to detect outcomes after primary angioplasty for ST-elevation/new left bundle branch block myocardial infarction (STEMI).
  
  
  METHODS
  Patients admitted to Auckland City Hospital for acute coronary catheterization with a diagnosis of STEMI between October 2010 and September 2011 were identified, and included if hs-TnT levels were measured at admission. Clinical characteristics and major adverse cardiovascular events (MACE: death, myocardial infarction and revascularization) at 30 days and 1 year were collected from national statistics and electronic medical records.
  
  
  RESULTS
  Median admission hs-TnT level in the 173 STEMI patients studied was 59 ng/L (interquartile range (IQR) 19-310). Incidences of MACE at 30 days and 1 year were 10% (n=17) and 18% (n=31), respectively. C-statistics and 95% confidence interval (CI) (95% CI) for hs-TnT on admission at detecting MACE at 30 days and 1 year were 0.800 (0.696-0.904) and 0.750 (0.655-0.845) respectively, with the optimal cut-point of 225 ng/L giving sensitivities/specificities of 76.5%/75.6% and 64.5%/78.2% respectively. Admission log(hs-TnT) independently predicted both MACE at 30 days with hazards ratio 5.16, 95% CI (2.25-11.9) and 1 year with hazards ratio 2.88, 95% CI (1.79-4.63), as did age and cardiogenic shock. Age, Maori or Pacific ethnicity and chronic respiratory disease were independent predictors of hs-TnT>225 ng/L.
  
  
  CONCLUSIONS
  Admission hs-TnT measured in primary angioplasty is strongly prognostic of MACE at 30 days and 1 year, even following adjustment for potential confounding variables.
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand.
authors.forename: Tom Kai Ming
authors.initials: TK
authors.lastname: Wang
authors.forename: Timothy A C
authors.initials: TA
authors.lastname: Snow
authors.forename: Yang
authors.initials: Y
authors.lastname: Chen
authors.forename: Hussam
authors.initials: H
authors.lastname: Rostom
authors.forename: Jonathon M
authors.initials: JM
authors.lastname: White
authors.forename: James T
authors.initials: JT
authors.lastname: Stewart
authors.forename: Mark W I
authors.initials: MW
authors.lastname: Webster
authors.forename: Peter N
authors.initials: PN
authors.lastname: Ruygrok
authors.forename: Timothy
authors.initials: T
authors.lastname: Watson
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: ST-elevation myocardial infarction; Troponin; acute coronary syndrome; primary angioplasty; prognosis