Utility of Cardiac Biomarkers in Predicting Infarct Size, Left Ventricular Function, and Clinical Outcome After Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

被引:190
作者
Chia, Stanley [1 ]
Senatore, Fred [3 ]
Raffel, O. Christopher [1 ]
Lee, Hang [2 ]
Wackers, Frans J. Th. [4 ]
Jang, Ik-Kyung [1 ]
机构
[1] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Ctr Biostat, Boston, MA 02114 USA
[3] Mitsubishi Pharma Amer, Warren, NJ USA
[4] Yale Univ, Sch Med, Cardiovasc Nucl Imaging & Stress Labs, New Haven, CT USA
基金
英国医学研究理事会;
关键词
angioplasty; cardiac biomarkers; infarct size myocardial infarction; ventricular function;
D O I
10.1016/j.jcin.2008.04.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives We sought to determine the best cardiac biomarker to predict infarct size, left ventricular ejection fraction (LVEF), and clinical outcome in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Background The cardiac biomarkers, creatine kinase (CK), CK-MB, and troponins T and I are routinely measured after myocardial infarction. However, their correlation with functional and clinical outcomes after PCI for STEMI is not well established. Methods In the EVOLVE (EValuation Of MCC-135 for Left VEntricular Salvage in Acute Myocardial Infarction) trial, patients were randomized to receive intracellular calcium modulator as adjunct to primary PCI for first large STEMI. Cardiac biomarker levels were determined in 378 patients before PCI and serially up to 72 h. Single-photon emission computed tomography was performed after 5 and 30 days, and patients were monitored up to 180 days. Results All single time-point, peak, and area under time-concentration curve of CK, CK-MB, and troponins T and I after PCI significantly correlated with infarct size and LVEF. In particular, 72-h troponin I (TnI72h) correlated strongly with 5-day and 30-day infarct size (r > 0.70; p < 0.001). A TnI72h threshold >55 ng/ml was 90% sensitive for large infarct size (>= 10%) and low LVEF (<= 40%) with specificities of 70% and 52%, respectively (c = 0.88, 0.81; p < 0.001). The highest TnI72h tertile was associated with increased 180-day composite clinical events (23% vs. 23% vs. 42%; p = 0.001) and independently predicted adverse events (hazard ratio = 2.3; p = 0.01). Conclusions Assessing TnI72h after primary PCI is a simple, effective method to estimate infarct size, LVEF, and potentially useful for risk stratification. (J Am Coll Cardiol Intv 2008;1:415-23) (C) 2008 by the American College of Cardiology Foundation
引用
收藏
页码:415 / 423
页数:9
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