Copyright © 2004 by the European Society of Cardiology.
Clinical research
Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction
a Department of Cardiology, University Hospital of Uppsala, Sweden
b Clinical Experimental Research Laboratory, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
c Department of Clinical Chemistry, University Hospital of Uppsala, Sweden
d Uppsala Clinical Research Centre, University Hospital of Uppsala, Sweden
Received April 29, 2003;
revised September 19, 2003;
accepted October 23, 2003
* Corresponding author: Erik Björklund, M.D., Dept. of Cardiology, Thoraxcenter, Academic Hospital, 751 85 Uppsala, Sweden. Tel.: +46-18-611-40-43; fax: +46-18-50-66-38
E-mail address: erik.bjorklund{at}thorax.uas.lul.se
This paper was guest edited by Prof. Harvey White, Department of Cardiology, Green Lane Hospital, New Zealand
Aims The prognostic value of admission troponin T (tnT) levels and the resolution of the ST-segment elevation in ST-elevation myocardial infarction (STEMI) is well established. However, the combination of these two early available markers for predicting risk has not been evaluated.
Methods and results We evaluated 516 patients with fibrinolytic treated STEMI from the ASSENT-2 and ASSENT-PLUS studies, which had both admission tnT and ST-monitoring available. We used a prospectively defined cut-off value of tnT of 0.1µg/l. For ST-segment resolution, a cut-off of 50% measured after 60min was used. Both a tnT 
0.1µg/l (n=116) and ST-segment resolution <50% (n=301) were related to higher one-year mortality, 13% vs 4% (P<0.001) and 8.4% vs 2.8% (P=0.009), respectively. In a multivariate analysis ST-segment resolution was and tnT showed a strong trend to be independently related to mortality. The combination of both further improved risk stratification. The one-year mortality in the group with elevation of tnT and without ST-segment resolution compared to the group without tnT elevation and with ST-segment resolution was 18.2% vs 2.8% (P<0.001).
Conclusion Both tnT on admission and ST-segment resolution after 60min are strong predictors of one-year mortality. The combination of both gives additive early information about prognosis and further improves risk stratification.
Key Words: Acute myocardial infarction • Troponin T • Electrocardiography • Prognosis
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