Different Prognostic Significance of Cardiac Troponin at Presentation and Peak Cardiac Troponin in Patients with Non-ST Segment Elevation Myocardial Infarction

Abstract

Objectives: Non-ST elevation myocardial infarction (NSTEMI) is one of the most common manifestations of acute coronary syndromes (ACS). We evaluated the prognostic role of cardiac troponin I (cTnI) at presentation and peak cardiac troponin I in patients with NSTEMI. Methods: We consecutively enrolled 215 subjects presenting with NSTEMI. Subjects were followed up for 1 year. cTnI at presentation and the peak value of cTnI were measured. The primary end point was defined as cardiovascular death, readmission to hospital with heart failure and new ACS. Results: The subjects who presented the primary end point (49 subjects) had significantly increased values of peak cTnI compared to subjects free of cardiovascular events [7.19 (2.97-21.32) vs. 4.09 (1.18-11.85) ng/l; p = 0.002]. Nevertheless, cTnI at presentation did not differ between subjects who presented the primary end point and those free of events (p = 0.39). Multivariate Cox regression analysis after adjustment for confounders revealed by the univariate analysis showed that for an increase in peak cTnI from 1 to 10 ng/l, there is a 60% anticipated increase in the relative risk to present the primary end point (p = 0.04). Conclusion: These findings documented the different prognostic significance of cTnI at presentation and peak cTnI in patients presenting with NSTEMI, and highlighted the importance of monitoring the levels of cTnI in this high-risk population.

Diagnostic Roles of Postmortem cTn I and cTn T in Cardiac Death with Special Regard to Myocardial Infarction: A Systematic Literature Review and Meta-Analysis

“…Due to the high sensitivity and specificity of myocardial injury, cardiac troponins are recommended by the European Society of Cardiology and the American College of Cardiology to be the primary choice and significant reference for the diagnosis of myocardial infarction [15,16,17]. The levels of cardiac troponins not only have the effect of diagnosing myocardial infarction but also can be used to assess the severity of infarction and prognosis in clinical medicine [18,19,20,21].…”

Cardiac Troponin Rapid Rule-Out Protocols in Suspected Acute Coronary Syndrome: The Faster the Better or a Loss of Information regarding Outcome and Adjunctive Therapy?

“…In this issue of Cardiology , Siasos et al [9] investigated the different prognostic significance of baseline and peak cTn levels in NSTEMI patients, with respect to the primary end points of cardiovascular death, readmission to hospital with heart failure and new ACS within a 1-year follow-up. Plasma cTn levels were monitored at baseline followed by serially sampling every 6 h for at least 36 h or 2 falling plasma concentrations.…”

“…A 10-fold increase in cTn levels was found to be associated with a 60% relative risk increase. Notably, in their study, plasma cTn levels at presentation failed to serve as an independent surrogate marker for a worse prognosis [9]. …”

“…Simultaneously, the question arises whether the implementation of such rapid rule-out protocols also favors better care of cTn-positive patients, reflected in the better prognosis [13,14]. With regard to risk stratification, according to the findings of Siasos et al [9], initial cTn levels are inferior to peak cTn values, thereby recommending routine serial cTn monitoring to identify those NSTEMI patients at a higher risk.…”