Serial and single time-point measurements of cardiac troponin T for prediction of clinical outcomes in patients with acute ST-segment elevation myocardial infarction
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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.
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).
Pts who had suffered any MACE during follow-up had higher cTnT values (median (25th/75th percentiles) on day 4 (3.16 µg/l (2.71/5.20) Vs. 2.1 µg/l (1.19/3.96), P = 0.0304), and higher peak cTnT values (5.11 µg/l (3.31/9.47) Vs. 2.92 µg/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 µg/l, n = 23), and in the upper cTnT tertile (3.35–20.68 µg/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 µg/l, n = 28) and 2.4-fold in the upper cTnT peak tertile (5.11–18.93 µg/l, n = 27). The optimal ROC cutoff for cTnT to predict the composite of MACE was 2.69 µg/l measured on day 4 and 2.85 µg/l for the cTnT peak.
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.