Risk stratification in patients with inferior acute myocardial infarction treated by percutaneous coronary interventions - The role of admission troponin T

Background-Cardiac troponin T (cTnT) elevations on admission indicate a hig h-risk subgroup of patients: with ST-segment elevation acute myocardial inf arction (AMI). This finding has been attributed to less effective reperfusi on after thrombolytic therapy. The aim of this study was to determine the r ole of admission cTnT on the efficacy of percutaneous coronary intervention s (PCIs) in inferior AMI, Methods and Results-One hundred fifty-nine consecutive patients with inferi or ST-segment AMI were enrolled and followed up for a mean of 448 days. Pat ients were stratified by cTnT on admission. A cTnT greater than or equal to 0.1 mug/L was found in 58% of patients. These patients had longer time inte rvals 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 mo rtalities. 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 <greater than or equal to>0.1 m ug/L (77.9% versus 96.9%, P<0.001). Coronary stenting reduced 30-day and lo ng-term cardiac mortality, particularly among cTnT-positive patients. In a multivariate analysis, cTnT indicated an <approximate to>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 l ower success rates of direct PCI and higher rates of cardiac events over th e short and long term. These patients benefit from coronary stenting.