Association between the level of high-sensitivity troponin I (Hs-Trop I) and major adverse cardiovascular events in patients with acute myocardial infarction of segment elevation (STEMI) with primary percutaneous coronary intervention (PCI)

https://doi.org/10.19106/JMedSci005401202203

Daniel Daniel(1), Firandi Saputra(2), Hendry Purnasidha Bagaswoto(3), Budi Yuli Setianto(4*)

(1) Undergraduate Program of Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada
(2) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(3) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(4) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(*) Corresponding Author

Abstract


ST-segment elevation myocardial infarction (STEMI) is a condition which increases the risk of developing major adverse cardiovascular events (MACEs). For patients with STEMI, an efficient method of risk stratification is necessary in order to evaluate the clinical outcome. Troponin has been commonly used in the diagnosis of both STEMI and NSTEMI. The use of high sensitivity assays of troponin has been extensively studied in order to measure the size of myocardial damage caused by STEMI. 

This study aimed to investigate the association between the level of high sensitivity troponin I (Hs-Trop I) and the incidence of MACEs in patients with primary percutaneous coronary intervention (PCI) in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. It

 was a cross-sectional observational analytic study involving a total of 195 patients. Data were obtained from both the SCIENCE (Sardjito Cardiovascular Intensive Care) registry and the medical record of Dr. Sardjito General Hospital. Pearson’s Chi square test to evaluate the association between variables was applied. To determine the effect of confounding variables, a multivariate analysis was used.

 A significant difference in the baseline characteristics between the supramedian and inframedian Hs-Trop I groups (cutoff value of 2063.8 ng/mL) in age, onset, total ischemic time, wire crossing time and the smoking history of both groups was observed. Bivariate analysis showed a significant associations between Hs-Trop I and MACEs (p = 0.033), acute heart failure (p = 0.009) as well as mortality (p = 0.024). Meanwhile, no significant association between Hs-Trop I and cardiogenic shock (p = 0.977) and malignant arrythmia (p = 0.551) was reported. Furthermore, multivariate analysis showed Hs-Trop I, age and wire crossing time were significantly associated with the incidence of MACEs (p = 0.045). In conclusion, there is a significant association between the Hs-Trop I levels and the MACEs events in STEMI patients with primary PCI in Dr. Sardjito General Hospital, Yogyakarta, Indonesia.


Keywords


high sensitivity troponin I; MACEs; primary PCI; STEMI; cardiogenic shock

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References


1.Vedanthan R, Seligman B, Fuster V. Global Perspective on Acute Coronary Syndrome. Cir Res 2014; 114(12):1959-75.
https://doi.org/10.1161/CIRCRESAHA.114.302782
2.Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017; 39(2):119-77.
https://doi.org/10.1093/eurheartj/ehx393
3.Poudel I, Tejpal C, Rashid H, Jahan N. Major adverse cardiovascular events: an inevitable outcome of ST-elevation myocardial infarction? A literature review. Cureus 2019; 11(7):e5280.
https://doi.org/10.7759/cureus.5280
4.Jaffe A, Ordonez-Llanos J. High-sensitivity cardiac troponin: from theory to clinical practice. Rev Esp Cardiol (Engl Ed) 2013; 66(9):687-91.
https://doi.org/10.1016/j.rec.2013.04.020
5.Hallén J. Troponin for the estimation of infarct size: what have we learned? Cardiology 2012; 121(3):204-12.
https://doi.org/10.1159/000337113
6.Reindl M, Holzknecht M, Tiller C, Lechner I, Schiestl M, Simma F, et al. Impact of infarct location and size on clinical outcome after ST-elevation myocardial infarction treated by primary percutaneous coronary intervention. Int J Cardiol 2020; 301:14-20.
https://doi.org/10.1016/j.ijcard.2019.11.123
7.Pride YB, Giuseffi, JL, Mohanavelu S, Harrigan CJ, Manning WJ, Gibson CM, et al. Relation between infarct size in ST-segment elevation myocardial infarction treated successfully by percutaneous coronary intervention and left ventricular ejection fraction three months after the infarct. Am J Cardiol 2010; 106(5):635-40.
https://doi.org/10.1016/j.amjcard.2010.04.012
8.Brezinov OP, Klempfner R, Zekry SB, Goldenberg I, Kuperstein R. Prognostic value of ejection fraction in patients admitted with acute coronary syndrome: A real world study. Medicine 2017; 96(9):e6226.
https://doi.org/10.1097/MD.0000000000006226
9.Reinstadler SJ, Klug G, Feistritzer HJ, Kofler M, Pernter B, Göbel G, et al. Prognostic value of left ventricular global function index in patients after ST-segment elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2016; 17(2):169-76.
https://doi.org/10.1093/ehjci/jev129
10.Kurmani S, Squire I. Acute heart failure: definition, classification and epidemiology. Curr Heart Fail Rep 2017; 14(5):385-92.
https://doi.org/10.1007/s11897-017-0351-y
11.Wanamaker BL, Seth MM, Sukul D, Dixon SR, Bhatt DL, Madder RD, et al. Relationship Between Troponin on Presentation and In‐Hospital Mortality in Patients With ST‐Segment–Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2019; 8(19):e013551.
https://doi.org/ 10.1161/JAHA.119.013551
12.Fox WR, Diercks DB. Troponin assay use in the emergency department for management of patients with potential acute coronary syndrome: current use and future directions. Clin Exp Emerg Med 2016; 3(1):1-8.
https://doi.org/10.15441/ceem.16.120
13.Attanasio F, Carrer P, Zurlo A, Rossi A, Babuin L, Mion MM, et al. Prognostic value of cardiac troponin I assay in hospitalized elderly patients. Aging Clin Exp Res 2019; 31(2):233-9.
https://doi.org/10.1007/s40520-018-0965-2
14.Sedighi SM, Nguyen M, Khalil A, Fülöp T. The impact of cardiac troponin in elderly patients in the absence of acute coronary syndrome: A systematic review. Int J Cardiol Heart Vasc 2020; 31:100629.
https://doi.org/10.1016/j.ijcha.2020.100629
15.Webb IG, Yam ST, Cooke R, Aitken A, Larsen PD, Harding SA. Elevated baseline cardiac troponin levels in the elderly - another variable to consider? Heart Lung Circ 2015; 24(2):142-48.
https://doi.org/10.1016/j.hlc.2014.07.071
16.Dudek D, Rakowski T, Dziewierz A, Mielecki W. Time delay in primary angioplasty: how relevant is it? Heart 2007; 93(10):1164-6.
https://doi.org/10.1136/hrt.2006.112805
17.Liem AL, van't Hof AW, Hoorntje JC, de Boer MJ, Suryapranata H, Zijlstra F. Influence of treatment delay on infarct size and clinical outcome in patients with acute myocardial infarction treated with primary angioplasty. J Am Coll Cardiol 1998; 32(3):629-33.
https://doi.org/10.1016/s0735-1097(98)00280-0
18.Chen YH, Huang SS, Lin SJ. TIMI and GRACE Risk Scores Predict Both Short-Term and Long-Term Outcomes in Chinese Patients with Acute Myocardial Infarction. Acta Cardiol Sin 2018; 34(1):4-12.
https://doi.org/10.6515/ACS.201801_34(1).20170730B



DOI: https://doi.org/10.19106/JMedSci005401202203

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