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. 2016 Jul 1;2(3):164-171.
doi: 10.1093/ehjqcco/qcv033.

Prognostic value of high sensitivity troponin T after ST-segment elevation myocardial infarction in the era of cardiac magnetic resonance imaging

Tuan L Nguyen  1   2 , John K French  1   2 , Jarred Hogan  2 , Leia Hee  1   2 , Daniel Moses  2   3 , Christian J Mussap  1   2 , Rohan Rajaratnam  1   2   4 , Craig P Juergens  1   2 , Hany R Dimitri  1   2 , David A B Richards  1   2 , Liza Thomas  1   2
Affiliations

Prognostic value of high sensitivity troponin T after ST-segment elevation myocardial infarction in the era of cardiac magnetic resonance imaging

Tuan L Nguyen et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aims: To determine if high sensitivity troponin T (hs-TnT) measurements performed during the 'plateau phase' of troponin release (≥48 h) following ST-segment elevation myocardial infarction (STEMI) can predict major adverse cardiovascular endpoints (MACE), and to evaluate its prognostic value compared with cardiac magnetic resonance imaging (CMRI) parameters.

Methods and results: We prospectively recruited 201 first presentation STEMI patients. Serial hs-TnT levels were measured at admission, peak (highest), 24, 48 and 72 h. CMRI and transthoracic echocardiography were performed (4 days median) post-STEMI, evaluating infarct scar characteristics and left ventricular ejection fraction (LVEF). Associations were determined between hs-TnT levels and CMRI parameters early after STEMI with MACE (comprising mortality, re-infarction, new or worsening of heart failure, cerebrovascular accident, and sustained ventricular arrhythmias) at medium-term follow-up. After 602 days (median), 33 (17%) patients had MACE. Upper tertile hs-TnT levels at 48 and 72 h were associated with MACE (Kaplan-Meier P = 0.002 and P = 0.012, respectively). Multivariate Cox analyses, incorporating diabetes, CMRI scar size, LVEF and hs-TnT levels (applied at a single hs-TnT time point) showed that 48 and 72 h hs-TnT levels were independent predictors for MACE (HR = 1.20, P = 0.002, and HR = 1.21, P = 0.035 respectively).

Conclusion: Measurement of hs-TnT in the plateau phase after STEMI is an inexpensive method of prognostic risk assessment.

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