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Admission cardiac troponin T improves risk stratification of patients with ST elevation myocardial infarction

Session Poster Session 2

Speaker Jose Anselmo Coelho Lima Junior

Congress : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Poster Session
  • FP Number : P523

Authors : J A Coelho Lima Junior (Newcastle upon Tyne,GB), J Ahmed (Newcastle upon Tyne,GB), G Georgiopoulos (Athens,GR), S Adil (Stoke on Trent,GB), D Gaskin (Newcastle upon Tyne,GB), C Bakogiannis (Newcastle upon Tyne,GB), F Ahmed (Newcastle upon Tyne,GB), H Ahmed (Newcastle upon Tyne,GB), A Bagnall (Newcastle upon Tyne,GB), K Stellos (Newcastle upon Tyne,GB), K Stamatelopoulos (Athens,GR), I Spyridopoulos (Newcastle upon Tyne,GB)

Authors:
J A Coelho Lima Junior1 , J Ahmed2 , G Georgiopoulos3 , S Adil4 , D Gaskin1 , C Bakogiannis1 , F Ahmed2 , H Ahmed2 , A Bagnall2 , K Stellos1 , K Stamatelopoulos3 , I Spyridopoulos1 , 1Newcastle University, Institute of Genetic Medicine - Newcastle upon Tyne - United Kingdom of Great Britain & Northern Ireland , 2Freeman Hospital, Department of Cardiology - Newcastle upon Tyne - United Kingdom of Great Britain & Northern Ireland , 3National & Kapodistrian University of Athens, Department of Clinical Therapeutics - Athens - Greece , 4Royal Stoke University Hospital, Respiratory unit - Stoke on Trent - United Kingdom of Great Britain & Northern Ireland ,

Citation:

Background: Mortality rates following ST elevation myocardial infarction (STEMI) remain high (˜ 20% 5-year all-cause mortality) despite routine use of primary percutaneous coronary intervention (PPCI). This highlights a need for improvement in patient risk stratification to aid secondary prevention post-STEMI. Small studies have suggested that admission high-sensitivity cardiac troponin T (hs-cTnT) might be prognostically relevant, but its role in STEMI patient risk stratification is unknown.

Purpose: To evaluate the prognostic ability of admission hs-cTnT in stratifying STEMI patients for risk of mortality.

Methods: Retrospective observational study including 3,113 consecutive STEMI patients undergoing PPCI between January 2010 and December 2014 at a single centre covering a population of 1.6 million in the north of England. Levels of hs-cTnT were determined at admission to the catheterisation laboratory.  Clinical, procedural, and laboratory data were collected from the local service database. All-cause mortality data were retrieved from the UK national registry (June/2017). The clinical end-points were in-hospital and overall mortality. Core clinical models for in-hospital and overall mortality prediction were determined by multivariate Cox-regression analyses. Kaplan-Meier survival and multivariate Cox-regression analyses were employed to evaluate the association between hs-cTnT and mortality. Net reclassification index (NRI) analysis was used to determine the power of hs-cTnT to reclassify patients into correct GRACE score categories for risk of in-hospital and overall mortality over the core predictive models. Data are presented as mean and standard deviation (±SD) or median and interquartile range, as appropriate. A p value < 0.05 was considered statistically significant.

Results: Mean age was 62.9 (±12.7) years. In-hospital mortality rate was 3% (n = 94) whereas overall mortality was 16.4% (n = 509) at a mean follow-up period of 51 (±21) months. Ascending quartiles of hs-cTnT were associated with increasing in-hospital and overall mortality (log rank < 0.001). Hs-cTnT values > 515ng/L (4th quartile) were independently associated with higher risk of in-hospital mortality [hazard ration (HR) per highest to lower quartiles = 2.39, p = 0.001] after adjusting for the core in-hospital mortality prediction model. Similarly, hs-cTnT levels > 515ng/L independently predicted overall mortality (HR per highest to lower quartiles = 1.25, p = 0.044) when adjusted for the core clinical model of overall mortality prediction. In addition, ascending quartiles of hs-cTnT correctly reclassified 43.9% (p < 0.001) and 48.4% (p < 0.001) of patients into risk categories for in-hospital and overall mortality, respectively.

Conclusion: Admission hs-cTnT is an independent predictor of mortality and improves risk stratification of STEMI patients post-PPCI. Future studies should assess its usefulness as a tool to guide secondary prevention in this population.



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