1. Usefulness of High Sensitivity Troponin T to Predict Long-Term Left Ventricular Dysfunction After ST-Elevation Myocardial Infarction.
- Author
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Mohammad MA, Koul S, Lønborg JT, Nepper-Christensen L, Høfsten DE, Ahtarovski KA, Bang LE, Helqvist S, Kyhl K, Køber L, Kelbæk H, Vejlstrup N, Holmvang L, Schoos MM, Göransson C, Engstrøm T, and Erlinge D
- Subjects
- Aged, Cardiac Imaging Techniques, Creatine Kinase, MB Form blood, Denmark, Echocardiography, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Percutaneous Coronary Intervention, Predictive Value of Tests, Prognosis, ROC Curve, ST Elevation Myocardial Infarction complications, ST Elevation Myocardial Infarction surgery, Stroke Volume, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left etiology, ST Elevation Myocardial Infarction blood, Troponin T blood, Ventricular Dysfunction, Left blood
- Abstract
Guidelines recommend the use of transthoracic echocardiography (TTE) and clinical scores to risk stratify patients after ST-elevation myocardial infarction (STEMI). High sensitivity troponin T (hs-cTnT) is predictive of outcome after STEMI but the predictive value of hs-cTnT relative to other risk assessment tools has not been established. We aimed to compare the predictive value of hs-cTnT to other risk assessment tools in patients with STEMI. A subset of 578 patients with STEMI were included in this post-hoc study from the Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction trial. Patients underwent cardiac magnetic resonance imaging (CMR) during index hospitalization as well as TTE at 1 year after their STEMI. The predictive value of hs-cTnT was compared with CKMB, infarct size (IS)/left ventricular ejection fraction (LVEF) assessed with CMR, LVEF assessed at discharge with TTE and the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk-scores. The primary outcome was LV systolic dysfunction defined as LVEF ≤40% after 1 year on TTE. The area under the receiver operating characteristic curve analyses showed no significant difference between hs-cTnT and early CMR-assessed IS or LVEF in predicting subsequent LVEF ≤40%. Area under the curve for hs-cTnT was 0.82, 0.85 for IS (p = 0.22), and 0.87 for LVEF (p = 0.23). For predischarge TTE-assessed LVEF, the value was 0.85 (p = 0.45), 0.63 for creatine kinase-MB (p <0.001), 0.61 for the GRACE score (p <0.001), and 0.70 for the TIMI score (p = 0.02). A peak hs-cTnT value <3,500 ng/L ruled out LVEF ≤40% with probability of 98%. In conclusion, in patients presenting with STEMI undergoing PCI, hs-cTnT level strongly predicted long-term LV dysfunction and could be used as a clinical risk stratification tool to identify patients at high risk of progressing to LV dysfunction due to its general availability and high-predictive accuracy., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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