TY - JOUR
T1 - Subclinical elevation of high-sensitive troponin T levels at the convalescent stage is associated with increased 5-year mortality after ST-elevation myocardial infarction
AU - OACIS Investigators
AU - Hara, Masahiko
AU - Sakata, Yasuhiko
AU - Nakatani, Daisaku
AU - Suna, Shinichiro
AU - Nishino, Masami
AU - Sato, Hiroshi
AU - Kitamura, Tetsuhisa
AU - Nanto, Shinsuke
AU - Hamasaki, Toshimitsu
AU - Hori, Masatsugu
AU - Komuro, Issei
N1 - Funding Information:
Dr Komuro has received research grants and speaker's fees from Takeda Pharmaceutical Company , Astellas Pharma , Daiichi Sankyo Company , Boehringer Ingelheim , Novartis Pharma , and Shionogi . No other authors have relationships with industry to disclose or financial associations that might pose a conflict of interest in connection with the submitted article.
Funding Information:
This work was supported by Grants-in-Aid for University and Society Collaboration (# 19590816 and # 19390215 ) from the Japanese Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan .
Publisher Copyright:
© 2015 Japanese College of Cardiology.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background: It is unclear whether serum high-sensitive troponin T (hs-TnT) levels at the convalescent stage of ST-elevation myocardial infarction (STEMI) are associated with long-term mortality. Methods: This study enrolled a total of 2944 consecutive STEMI patients who were registered in the Osaka Acute Coronary Insufficiency Study between 2000 and 2009, and whose hs-TnT levels were evaluated at the convalescent stage. Patients were divided into four hs-TnT category groups according to the results of survival classification and regression tree (CART) analysis. The impact of hs-TnT levels on 5-year mortality was evaluated using multivariate Cox regression analysis. Results: Only one patient had hs-TnT level below the detection limit of the assay (<0.003 ng/mL). The median hs-TnT level was 0.025 (quartile 0.011-0.083) ng/mL. During the median follow-up period of 1782 days, 188 patients died. Survival CART analysis revealed that the 1st, 2nd, and 3rd discriminating hs-TnT levels to discern 5-year mortality were 0.028, 0.008, and 1.340 ng/mL, respectively. The adjusted hazard ratios for the medium-low (0.009-0.028 ng/mL), medium-high (0.029-1.340 ng/mL), and high-risk (≥1.341 ng/mL) groups were 3.03 (95% confidence interval 1.18-7.77, p = 0.021), 4.29 (1.63-11.28, p = 0.003), and 8.68 (2.20-34.27, p = 0.002), respectively. Integrated discrimination improvement (IDI) analysis revealed that incorporation of this hs-TnT classification scheme with other clinical variables statistically improved the discriminatory accuracy for 5-year mortality, with a time-dependent IDI of 0.0076 (p = 0.033). Conclusions: hs-TnT levels at the convalescent stage were associated with long-term mortality in STEMI patients. Even subclinical elevation of hs-TnT levels was associated with increased 5-year mortality.
AB - Background: It is unclear whether serum high-sensitive troponin T (hs-TnT) levels at the convalescent stage of ST-elevation myocardial infarction (STEMI) are associated with long-term mortality. Methods: This study enrolled a total of 2944 consecutive STEMI patients who were registered in the Osaka Acute Coronary Insufficiency Study between 2000 and 2009, and whose hs-TnT levels were evaluated at the convalescent stage. Patients were divided into four hs-TnT category groups according to the results of survival classification and regression tree (CART) analysis. The impact of hs-TnT levels on 5-year mortality was evaluated using multivariate Cox regression analysis. Results: Only one patient had hs-TnT level below the detection limit of the assay (<0.003 ng/mL). The median hs-TnT level was 0.025 (quartile 0.011-0.083) ng/mL. During the median follow-up period of 1782 days, 188 patients died. Survival CART analysis revealed that the 1st, 2nd, and 3rd discriminating hs-TnT levels to discern 5-year mortality were 0.028, 0.008, and 1.340 ng/mL, respectively. The adjusted hazard ratios for the medium-low (0.009-0.028 ng/mL), medium-high (0.029-1.340 ng/mL), and high-risk (≥1.341 ng/mL) groups were 3.03 (95% confidence interval 1.18-7.77, p = 0.021), 4.29 (1.63-11.28, p = 0.003), and 8.68 (2.20-34.27, p = 0.002), respectively. Integrated discrimination improvement (IDI) analysis revealed that incorporation of this hs-TnT classification scheme with other clinical variables statistically improved the discriminatory accuracy for 5-year mortality, with a time-dependent IDI of 0.0076 (p = 0.033). Conclusions: hs-TnT levels at the convalescent stage were associated with long-term mortality in STEMI patients. Even subclinical elevation of hs-TnT levels was associated with increased 5-year mortality.
KW - Classification and regression tree
KW - High-sensitive troponin T
KW - Integrated discrimination improvement
KW - Mortality
KW - ST-elevation myocardial infarction
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U2 - 10.1016/j.jjcc.2015.08.021
DO - 10.1016/j.jjcc.2015.08.021
M3 - Article
C2 - 26433912
AN - SCOPUS:84958835489
VL - 67
SP - 314
EP - 320
JO - Journal of Cardiology
JF - Journal of Cardiology
SN - 0914-5087
IS - 4
ER -