Prognostic Value of Cardiac Troponin T After Myocardial Infarction: A Contemporary Community Experience

Abstract

Objective: To evaluate the role of cardiac troponin T (cTnT) in predicting death, recurrent ischemic events, and heart failure among community-dwelling persons with first myocardial infarction (MI). Patients and Methods: Consecutive Olmsted County, Minnesota, residents with an incident MI between November 6, 2002, and December 31, 2007, were studied (Nϭ1177; mean age, 68 years). Maximal cTnT value was measured at a median of 1 day after MI (median, 0.52 ng/mL; interquartile range, 0.16-1.75 ng/mL) and evaluated as a prognostic factor using measures of absolute risk. Results: During a mean follow-up of 16 months, 276 deaths (23%) occurred, 341 patients (29%) experienced a recurrent ischemic event, and 326 patients (28%) experienced heart failure. A dose-response relationship was demonstrated early after MI between cTnT and the adjusted cumulative incidence of all outcomes. The multivariateadjusted absolute risk differences (events per 100 patients) between the upper and lower cTnT tertiles at 30 days were 5.8 (95% confidence interval [CI], 1.4-10.2) for death, 5.2 (95% CI, 0.2-10.3) for recurrent ischemic event, and 6.9 (95% CI, 1.4-12.4) for heart failure. These differences were either maintained or increased at 2 years. Conclusion: In the community, cTnT level predicts death and nonfatal cardiac events independently of other prognostic factors. The increased risk associated with elevated cTnT level appears shortly after MI and persists for at least 2 years.

Atherosclerotic Burden and Heart Failure After Myocardial Infarction

“…Thus, although recurrent MI was associated with HF risk (HR=4.01, 95% CI: 3.03–5.30), it did not substantially confound the CAD-HF association. Similarly, infarct size, as estimated by creatine kinase-MB and cardiac troponin T, has been shown to be associated with HF risk after MI , 26 but no association was observed between the biomarkers and more extensive CAD (p for trend=0.64 and 0.91 for creatine kinase-MB and cardiac troponin T, respectively). Thus infarct size did not substantially confound the CAD-HF association either.…”

“…Recurrent MI (occurrence and date) data were obtained via the Rochester Epidemiology Project on the basis of clinical diagnoses. 26 …”

Prognostic Value of Soluble ST2 After Myocardial Infarction: A Community Perspective

“…As previously described, 8 the validation of myocardial infarction relied on standard algorithms integrating cardiac pain, electrocardiographic (ECG) and biomarker data. According to current guidelines, each case was classified by troponin T. 9 In clinical practice, serial troponin T measurements were performed after infarction onset.…”

Detection of apoptosis in patients with coronary artery disease : Assessment of temporal patterns and potential sources

“…Interes levels of sFasL a not in other lym and B cell lymph NK cell prolifera therapy when N In the presen sFasL and circula time point. Such [10,11] Fig. 10.…”

“…Urgent re-opening of the occluded infarct-related artery by percutaneous coronary intervention (PCI) is the treatment of choice to limit ischemic injury [10]. The infarct size, determined by measurement of myocardial markers in the circulation (such as troponins) or by cardiac magnetic resonance imaging, is strongly correlated to future morbidity and mortality [11][12][13][14].…”