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Role of biomarkers in assessment of early infarct size after successful p-PCI for STEMI

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Abstract

Objective

The aim of the study was to find out if single time point and estimated cumulative release of cardiac troponin T (cTnT) and creatine kinase (CK) correlate with early infarct size and left ventricular function measured by cardiac magnetic resonance (CMR).

Methods

CMR and serial CK and cTnT measurements were performed in 103 patients (85 male, mean age 55.8 ± 12.1 years) within at least 8 days (3.1 ± 1.5 days) after first acute myocardial infarction and successful primary percutaneous coronary interventions. Infarct size was determined on delayed gadolinium-enhanced phase-sensitive IR-SSFP CMR sequences. Single time point, peak and cumulative cardiac protein release were correlated with infarct size.

Results

All single time point, peak and estimated cumulative release of CK and cTnT values except on admission showed significant correlations with infarct size. Among single time point values, cTnT after 96 h (cTnT96; r = 0.680, p < 0.001) and CK after 24 h (CK24; r = 0.699, p < 0.001) showed the closest correlations with infarct size. Peak CK and cTnT levels correlated only slightly better than single time point values (r = 0.703 and 0.688, p < 0.001), whereas cumulative release values did not show closer correlations than single point values. Receiver-operator characteristics analysis showed that cTnT96 and CK24 detected large infarct areas (>16.8 g) and decreased left ventricular function (EF < 40%) with high sensitivity and specificity.

Conclusion

Both single time point cTnT concentrations and CK activities correlate well with infarct size early after primary PCI for STEMI. Cardiac TnT levels determined 3–4 days after revascularization for acute myocardial infarction allow for a good estimation of acute infarct size as well as an approximation of LV function and morphology.

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Abbreviations

AMI:

Acute myocardial infarction

CK:

Creatine kinase

CI:

Confidence interval

(CE)-CMR:

(Contrast-enhanced) cardiac magnetic resonance

EDV:

End-diastolic volume

ESV:

End-systolic volume

cTn(T/I):

Cardiac troponin (T/I)

(LV)EF:

(Left ventricular) ejection fraction

(LV)MM:

(Left ventricular) myocardial mass

ND:

Normally distributed

(p-)PCI:

(Primary) percutaneous coronary interventions

(PS)IR-SSFP:

(Phase-sensitive) inversion recovery-SSFP

ROC:

Receiver-operator characteristics

SD:

Standard deviation

SV:

Stroke volume

STEMI:

ST-segment elevation myocardial infarction

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Acknowledgments

We thank Rajam Csordas-Iyer for critical reading of the manuscript.

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Authors and Affiliations

  1. University Clinic of Internal Medicine III, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Gert Klug, Agnes Mayr, Johannes Mair, Michael Nocker, Otmar Pachinger & Bernhard Metzler

  2. Department of Radiology I, Medical University of Innsbruck, Innsbruck, Austria

    Michael Schocke, Thomas Trieb & Werner Jaschke

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  1. Gert Klug
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  2. Agnes Mayr
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  3. Johannes Mair
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Correspondence to Bernhard Metzler.

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Klug, G., Mayr, A., Mair, J. et al. Role of biomarkers in assessment of early infarct size after successful p-PCI for STEMI. Clin Res Cardiol 100, 501–510 (2011). https://doi.org/10.1007/s00392-010-0273-0

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  • DOI: https://doi.org/10.1007/s00392-010-0273-0

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