Open AccessPrognostic Value of New‐Generation Troponins in ST ‐Segment–Elevation Myocardial Infarction in the Modern Era: The RUTI ‐ STEMI Study
Author(s) -
Cediel Germán,
Rueda Ferran,
García Cosme,
Oliveras Teresa,
Labata Carlos,
Serra Jordi,
Núñez Julio,
Bodí Vicent,
Ferrer Marc,
Lupón Josep,
BayesGenis Antoni
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.007252
Subject(s) - medicine , hazard ratio , cardiology , percutaneous coronary intervention , myocardial infarction , killip class , ejection fraction , troponin , confidence interval , proportional hazards model , coronary artery disease , heart failure
Background In ST ‐segment–elevation myocardial infarction ( STEMI ), troponins are not needed for diagnosis: symptoms and ECG data are sufficient to activate percutaneous coronary intervention. This study explored the prognostic value of new‐generation troponins in a real‐life cohort contemporarily treated for STEMI . Methods and Results We studied 1260 consecutive patients with primary STEMI treated with percutaneous coronary intervention between February 22, 2011, and August 31, 2015. We collected data on clinical characteristics and major adverse cardiovascular and cerebrovascular events ( MACCEs ) at 30 days and 1 year. Peak high‐sensitivity troponin T and sensitive‐contemporary troponin I levels were recorded. MACCE s occurred in 75 patients (6.1%) by day 30 and in 124 patients (10.8%) between day 31 and 1 year. A short‐term (0–30 days) multivariable Cox regression analysis revealed that age, Killip‐Kimball class, and left ventricular ejection fraction were independent predictors of MACCE s. In adjusted analysis, peak high‐sensitivity troponin T and sensitive‐contemporary troponin I were not significant (hazard ratio, 1.23 [95% confidence interval, 0.98–1.54] [ P =0.071]; and hazard ratio, 1.15 [95% confidence interval, 0.93–1.43] [ P =0.200], respectively). A long‐term (31 days–1 year) multivariable Cox regression analysis revealed that age, female sex, diabetes mellitus, prior coronary artery disease, Killip‐Kimball class, and left ventricular ejection fraction were statistically significantly associated with MACCEs . However, peak high‐sensitivity troponin T and peak sensitive‐contemporary troponin I were not significantly associated with MACCEs (hazard ratio, 1.03 [95% confidence interval, 0.88–1.20] [ P =0.715]; and hazard ratio, 0.99 [95% confidence interval, 0.85–1.15] [ P =0.856], respectively). Conclusions In the modern era, new‐generation troponins do not provide significant prognostic information for predicting clinical events in STEMI . We should reconsider the value of serial troponin measurements for risk stratification in STEMI .