The prognostic significance of elevated troponin I on admission in acute myocardial infarction patients who underwent multivessel percutaneous coronary intervention

Hong, Young Joon; Jeong, Myung Ho; Lee, Seung Hyun; Park, Ok Young; Park, Woo Seok; Kim, Ju Han; Kim, Weon; Ahn, Young Keun; Cho, Jeong Gwan; Suh, Soon Pal; Park, Jong Chun; Ahn, Byoung Hee; Kim, Sang Hyung; Kang, Jung Chaee

Abstract

BACKGROUND: Cardiac troponin I (cTnI) is a sensitive and specific biomarker for myocardial injury. The aim of this study was to determine the significance of clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI), major adverse cardiac events and event-free survival rate after PCI according to the value of cTnI on admission in acute myocardial infarction (AMI) patients with multivessel lesions.
METHODS
A total of 154 patients with AMI who underwent multivessel PCI between June 2000 and December 2001 at Chonnam National University Hospital were divided into two groups: Group I (n=70, 61.5+/-10.5 years, male 81.4%) with cTnI less than 10 ng/mL (6.9+/-4.7 ng/mL) and Group II (n=84, 60.8+/-10.0 years, male 75.0%) with cTnI higher than 10 ng/mL (57.4+/-40.0 ng/mL) on admission.
RESULTS
Baseline ejection fraction of the left ventricle (LV) was lower in Group II than in Group I (Group I; 58.8+/-13.6% vs. Group II; 51.6+/-7.9%, p=0.002). Thrombolysis in Myocardial Infarction (TIMI) flow was higher in Group I than in Group II (2.86+/-1.24 vs. 2.42+/-1.37, p=0.024) and the diameter stenosis was less severe in Group I than in Group II (92.2+/-7.2% vs. 96.4+/-5.4%, p=0.020). The number of stents placed was lower in Group I than in Group II (1.45+/-0.50 vs. 1.63+/-0.70, p=0.023). The event-free survival rate was higher in Group I than in Group II during hospitalization and 12-month clinical follow-up after PCI (87.1% vs. 69.0%, 72.9% vs. 50.0%, p=0.008, 0.004, respectively). The independent predictors for target lesion revascularization were lesion length, CRP level on admission, stent use, diabetes mellitus, cTnI on admission (p=0.001, 0.009, 0.012, 0.019, 0.035, respectively) and the independent predictors for 1-year mortality were cardiogenic shock on admission, CRP level on admission, cTnI on admission (p<0.001, =0.005, 0.021, respectively). CONCLSUION: The high level of cTnI on admission is associated with LV dysfunction, low grade of TIMI flow and lower long-term event-free survival rate during hospitalization and at 12-month after PCI in patients with AMI.