Possible reasons for the prognostic value of troponin-T on admission in patients with ST-elevation myocardial infarction

Background In patients with acute myocardial infarction and ST-segment elev ation, increased troponin-T (TnT) on admission implies an increased mortali ty. Objective To elucidate the underlying mechanisms of the prognostic value of TnT. Methods and results One hundred and one patients were included and all rece ived thrombolytic treatment, The patients were compared according to TnT le vel on admission (cut-off 0.1 mug/l). Elevation of TnT was associated with long-term mortality and also with longer delay, more episodes of chest pain during the last 24 h and fewer noninvasive signs of reperfusion at 90 min. In the group with elevated TnT, the coronary angiography at 24 h showed a strong trend towards lower patency in the infarct-related artery. TnT was a lso associated with increased infarct size if a higher cut-off level (0.43 mug/l) was used, In univariate analysis, elevated TnT, longer delay, repeat ed chest pain a-waves on admission and reduced left ventricular (LV) functi on were significantly associated with long-term mortality. In multivariate models, only reduced LV function and less than TIMI (thrombolysis in myocar dial infarction) grade 3 flow turned out to be significant independent risk factors. Conclusions The prognostic value of TnT level on admission regarding long-t erm mortality was confirmed and seems mainly to be explained by its associa tion with longer delay and recent myocardial damage, but its association wi th reduced effect of thrombolytic treatment, larger infarct size and impair ed LV function might also be of importance. Coron Artery Dis 12:227-237 (C) 2001 Lippincott Williams & Wilkins.