title: Discordant cardiac biomarker levels independently predict outcome in ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  To investigate the prognostic relevance of elevated Troponin T (cTnT) levels in patients with ST-segment elevation myocardial infarction (STEMI) without significant creatine kinase (CK) elevation on admission.
  
  
  RESULTS
  From January 1, 2002 to December 31, 2006 patients with STEMI without significant CK elevation (<2-fold) on admission treated with percutaneous coronary intervention (PCI) were included and stratified according to cTnT plasma levels. Univariate and multivariate regression analyses were used to find independent predictors for mortality. During the 5-year period 514 patients with STEMI and normal CK plasma levels were included. 308 (59.9 %) patients had cTnT levels <0.1 μg/l and 206 (40.1 %) patients had cTnT levels ≥0.1 μg/l. Multivariate logistic regression analysis identified cTnT levels ≥0.1 μg/l and 3-vessel disease as positive, and hemoglobin levels as negative independent predictors for long-term mortality. Discordantly elevated cTnT plasma levels independently predicted higher mortality rates in the first year (HR 3.9, 95 % CI 1.7-9.1, p = 0.002) and during 5 years (HR 2.3, 95 % CI 1.4-3.9, p = 0.002) after PCI for STEMI.
  
  
  CONCLUSIONS
  Discordant elevation of cTnT in the presence of normal CK plasma levels on admission is associated with increased mortality in STEMI patients undergoing primary PCI. This may be due to preceding microembolization.
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Leibundgut
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gick
authors.affiliation: Pôle d'activité médico-chirurgicale Cardiovasculaire, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Morel
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Miroslaw
authors.initials: M
authors.lastname: Ferenc
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Werner
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Comberg
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Rolf-Peter
authors.initials: RP
authors.lastname: Kienzle
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
authors.forename: Heinz Joachim
authors.initials: HJ
authors.lastname: Buettner
authors.affiliation: Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany. franz-josef.neumann@universitaets-herzzentrum.de.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C545568:TNNT2 protein, human; D020107:Troponin T; D003402:Creatine Kinase
keywords: Cardiac biomarkers; Embolization; Mortality; ST-segment elevation myocardial infarction