Measurement of the peak level of cardiac troponin I in myocardial infarction with ST-segment elevation as a method of estimating the amount of irreversibly damaged

• Frolov A.A.

Abstract

The aim of the study is to determine the vaLue of the peak LeveL of cardiac troponin I (picp) after reperfusion therapy for myocardiaL infarction with ST-segment eLevation (STEMI) as a method for evaLuating the voLume of irreversibLy damaged myocardium (PBNPA) and predict Long-term adverse outcomes.

Material and methods. Conducted a singLe-center prospective observationaL study. IncLuded 83 consecutiveLy admitted patients with a STEMI without prior coronary history. Of these, 68 (82%) men and 15 (18%) women (mean age of 54.7±10.8 years). Primary percutaneous coronary intervention performed in 26 (31%) cases, a pharmacoinvasive approach has been used in 40 (48%) patients, isoLated thromboLytic therapy was performed in 17 (21%). The resuLts of reperfusion noted her efficiency and time «symptom-reperfusion». The success of the reperfusion was confirmed on seLective coronary angiography. The importance of infarct-reLated coronary artery were assessed using the BCIS-1 Myocardial Jeopardy score (IA). From the time of admission and before the end of 3 days every 12 hours to determine the Level of cardiac troponin I and recorded pict. During the 12-month observation period tracked the development of serious adverse cardiac events (MACE): cardiovascular death, nonfatal myocardial infarction, repeat revascularization in patients previously operated on for coronary artery stent thrombosis. After 12 months conducted 6-minute walk test, performed echocardiography, were measured the Levels of N-terminaL fragment of brain natriuretic peptide in the blood. Based on these data, concLuded the formation of chronic heart failure (CHF) and determined its functionaL cLass (FC) NYHA cLassification. Quantitative data are presented as median and interquartile intervaLs (Median [Q1; Q3]).

Results. At the stage of inpatient treatment picp was significantLy Lower in patients with effective reperfusion (27.3 [11.7; 37.0] vs 50.0 [36.1; 50.0] ng/mL, p=0.001). VaLue picp correLated with OA (R=0.32, p=0.003) and the time "symptom-reperfusion injury" (R=0.24, p=0.05). HospitaL mortaLity was 3.6% (3 patients died). Over the next 12 months there were no LethaL outcomes, MACE occurred in 9 (11%) patients, with CHF II-IV FC were detected in 41 patients (51% of the 80 survivors). Among patients who deveLoped MACE, pict 26.1 [21.1; 45.6] ng/mL, otherwise 32.0 [15.0; 50.0] ng/mL (p=0.99). In the group of patients with CHF II-IV FC, pitp was equaL to 45.0 [26.5; 50.0] ng/mL in patients without a cLinicaL picture of CHF - 16.9 [4.3; 32.0] ng/mL (p<0.001).

Conclusions. Measurement pict with STEMI can be used to assess PBNPA. The vaLue pitp associated with the formation of the CHF in the remote period of observation.

Keywords:heart failure, peak cardiac troponin I, reperfusion therapy for myocardial infarction with ST-segment elevation

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