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(Circulation. 2000;102:2038.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Risk Stratification in Patients With Inferior Acute Myocardial Infarction Treated by Percutaneous Coronary Interventions
The Role of Admission Troponin T
From the Medizinische Klinik II, Medizinische Universität zu Lübeck, Lübeck, Germany.
Correspondence to Professor Hugo A. Katus, Medizinische Klinik II, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail Katus{at}medinf.mu-luebeck.de
Background—Cardiac troponin T (cTnT) elevations on admission indicate a high-risk subgroup of patients with ST-segment elevation acute myocardial infarction (AMI). This finding has been attributed to less effective reperfusion after thrombolytic therapy. The aim of this study was to determine the role of admission cTnT on the efficacy of percutaneous coronary interventions (PCIs) in inferior AMI.
Methods and Results—One hundred fifty-nine consecutive patients
with inferior ST-segment AMI were enrolled and followed up
for a mean of 448 days. Patients were stratified by cTnT on admission.
A cTnT 
0.1 µg/L was found in 58% of patients. These patients had
longer time intervals from onset of symptoms to therapy
(P<0.001) and higher 30-day (10.8% versus 1.5%,
P=0.027) and long-term (17.2% versus 4.5%,
P=0.023) cardiac mortalities. Rates of the combined end
point of death, nonfatal reinfarction, and need for repeated target
vessel revascularization procedures were not
different in cTnT groups (log rank, 0.69; P=0.41). PCI
was attempted in 93.3% of cTnT-positive and 98.5% cTnT-negative
patients (P=0.24) but was less frequently successful in
patients with cTnT 0.1 µg/L (77.9% versus 96.9%,
P<0.001). Coronary stenting reduced 30-day and
long-term cardiac mortality, particularly among cTnT-positive patients.
In a multivariate analysis, cTnT indicated an
5-fold-higher risk (adjusted OR, 4.6; 95% CI, 0.79 to 27.11;
P=0.089) and was a strong albeit not independent risk
predictor.
Conclusions—In inferior AMI, a positive admission cTnT is associated with lower success rates of direct PCI and higher rates of cardiac events over the short and long term. These patients benefit from coronary stenting.
Key Words: myocardial infarction • risk factors • troponin T
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