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Troponin I concentrations following primary percutaneous coronary intervention predict large infarct size and left ventricular dysfunction in patients with ST-segment elevation acute myocardial infarction

      Abstract

      The aim of this study was to investigate the ability of troponin I (cTnI) levels to predict myocardial infarction size in patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). In 87 patients with STEMI undergoing primary PCI, serial plasma concentrations of cTnI and α-hydroxybutyrate deshydrogenase (HBDH) were measured before PCI and over the following 72 h. Enzymatic infarct size was estimated by the cumulative release of HBDH during the 72 h following PCI (QHBDH72). Delayed radionuclide left ventricular ejection fraction (LVEF) was measured in 63 patients. While cTnI concentrations at admission did not correlate with QHBDH72 or with LVEF, from the 3rd to the 72nd h following PCI, they did correlated with QHBDH72 (P<0.001; r: 0.76–0.86) and with LVEF (P<0.001; r: −0.42 to −0.50). Receiver–operator characteristic (ROC) curve analysis showed that admission concentrations of cTnI could not predict either a large infarct size (i.e., QHBDH72>10 g-eq l−1) or a low LVEF (i.e., LVEF<40%). However, 6 h and up until 72 h after PTCA, cTnI concentrations were predictive of large enzymatic infarct size (sensitivity: 91 and 95%, specificity: 90 and 87%, respectively) and of LVEF under 40% (sensitivity: 75 and 77%, specificity: 90 and 78%, respectively). Thus, our study suggests that in contrast with admission cTnI concentration, cTnI levels following primary PCI represent a reliable tool for predicting large enzymatic infarct size and may help in selecting patients with a high risk of low LVEF at 1 month.

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      References

        • Baardman T.
        • Hermens W.T.
        • Lenderink T.
        • Molhoek G.P.
        • Grollier G.
        • Pfisterer M.
        • Simoons M.L.
        Differential effects of tissue plasminogen activator and streptokinase on infarct size and the rate of enzyme release: influence of early infarct related artery patency. The GUSTO enzyme substudy.
        Eur. Heart J. 1996; 17: 237-246
      1. The Multicenter Postinfarction Research Group. Risk stratification and survival after acute myocardial infarction, N. Engl. J. Med. 1983;309:331–6.

        • Herlitz J.
        • Hjalmarson A.
        • Waldenstrom J.
        Relationship between different enzymatic estimations of the infarct size.
        Acta Cardiol. 1985; 40: 217-218
        • Van der Laarse A.
        • Vermeer F.
        • Hermens W.T.
        • et al.
        Effects of early intracoronary streptokinase on infarct size estimated from cumulative enzyme release rate: a randomized trial of 533 patients with acute myocardial infarction.
        Am. J. Heart. 1986; 12: 672-681
        • Willems G.M.
        • Muijtes A.M.M.
        • Lambi F.H.H.
        • Hermens W.T.
        Estimation of circulatory parameters in patients with acute myocardial infarction: significance of circulation of enzymatic infarct size.
        Cardiovasc. Res. 1979; 13: 578-587
        • Van der Laarse A.
        • Hermens W.T.
        • Hollaar L.
        • et al.
        Assessment of myocardial damage in patients with acute myocardial infarction by serial measurement of serum alpha-hydroxybutyrate deshydrogenase levels.
        Am. Heart J. 1984; 107: 248-260
        • Van der Laarse A.
        • Kerkhof P.L.M.
        • Vermeer F.
        • et al.
        Relation between infarct size and left ventricular performance assessed in patients with first acute myocardial infarction randomized to intracoronary thrombolytic therapy or to conventional treatment.
        Am. J. Cardiol. 1988; 61: 1-7
        • Simoons M.L.
        • Serruys P.W.
        • Van der Brand M.
        • et al.
        Early thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival.
        J. Am. Coll. Cardiol. 1986; 7: 717-728
      2. Van de Werf F, Arnold AER, for the European Cooperative Study Group for recombinant tissue type plasminogen activator. Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction, Br. Med. J. 1988;297:1374–9.

        • De Boer M.J.
        • Suryapranata H.
        • Hoorntje J.C.A.
        • et al.
        Limitation of infarct size and preservation of left ventricular function after primary coronary angioplasty compared with intravenous streptokinase in acute myocardial infarction.
        Circulation. 1994; 90: 753-761
        • Ohman E.M.
        • Armstrong P.W.
        • Christenson R.H.
        • Granger C.B.
        • Katus H.A.
        • Hamm C.W.
        Cardiac troponin T levels for risk stratification in acute myocardial ischemia.
        N. Engl. J. Med. 1996; 335: 1333-1341
        • Antman E.M.
        • Tanasijevic M.J.
        • Thompson B.
        • Schactman M.
        • McCabe C.H.
        • Cannon C.P.
        • Fischer G.A.
        Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes.
        N. Engl. J. Med. 1996; 335: 1342-1349
      3. The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined—A consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction, J. Am. Coll. Cardiol. 2000;36:959–69.

        • Jaffe A.S.
        • Ravkilde J.
        • Roberts R.
        • Naslund U.
        • Apple F.S.
        • Galvani M.
        • Katus H.
        It's time for a change to a troponin standard.
        Circulation. 2000; 102: 1216-1220
        • Newby L.K.
        • Christenson R.H.
        • Ohman E.M.
        • et al.
        Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes. The GUSTO-IIa Investigators.
        Circulation. 1998; 98: 1853-1859
        • Stubbs P.
        • Collinson P.
        • Moseley D.
        • Greenwood T.
        • Noble M.
        Prognostic significance of admission troponin T concentrations in patients with myocardial infarction.
        Circulation. 1996; 94: 1291-1297
        • Matetzky S.
        • Sharir T.
        • Domingo M.
        • Noc M.
        • Chyu K.Y.
        • Kaul S.
        • Eigler N.
        • Shah P.K.
        • Cercek B.
        Elevated troponin I level on admission is associated with adverse outcome of primary angioplasty in acute myocardial infarction.
        Circulation. 2000; 102: 1611-1616
        • Giannitsis E.
        • Lehrke S.
        • Wiegand U.K.
        • et al.
        Risk stratification in patients with inferior acute myocardial infarction treated by percutaneous coronary interventions: the role of admission troponin T.
        Circulation. 2000; 102: 2038-2044
        • Frostfeldt G.
        • Gustafsson G.
        • Lindahl B.
        • Nygren A.
        • Venge P.
        • Wallentin L.
        Possible reasons for the prognostic value of troponin-T on admission in patients with ST-elevation myocardial infarction.
        Coron. Artery Dis. 2001; 12: 227-237
        • Bertinchant J.P.
        • Larue C.
        • Pernel I.
        • et al.
        Release kinetics of serum cardiac troponin I in ischemic myocardial injury.
        Clin. Biochem. 1996; 29: 587-594
        • Tanaka H.
        • Abe S.
        • Yamashita T.
        • et al.
        Serum levels of cardiac troponin I and troponin T in estimating myocardial infarct size soon after reperfusion.
        Coron. Artery Dis. 1997; 8: 433-439
        • Hara S.
        • Horinaka S.
        • Tsuchiya N.
        • Yabe A.
        • Asakawa H.
        • Yagi H.
        Cardiac troponin I level correlates with chronic-phase left ventricular function after successful direct percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction.
        J. Cardiol. 2000; 36: 303-310
        • Brodie B.R.
        • Stuckey T.D.
        • Hansen C.J.
        • Muncy D.B.
        • Weintraub R.A.
        • Kelly T.A.
        • Berry J.J.
        Timing and mechanism of death determined clinically after primary angioplasty for acute myocardial infarction.
        Am. J. Cardiol. 1997; 79: 1586-1591
        • Rao A.C.R.
        • Collinson P.O.
        • Canepa-Anson R.
        • Joseph S.P.
        Troponin T measurement after myocardial infarction can identify left ventricular ejection of less than 40%.
        Heart. 1998; 80: 223-225