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

Abstract

Assessing TnI72h after primary PCI is a simple, effective method to estimate infarct size, LVEF, and potentially useful for risk stratification.

Association Between Left Ventricular Global Longitudinal Strain and Adverse Left Ventricular Dilatation After ST-Segment–Elevation Myocardial Infarction

“…Although measurement of creatinine kinase or troponin T levels is widely available, their accuracy to predict LV remodeling is modest. 4,5 Alternatively, contrast-enhanced magnetic resonance imaging can accurately quantify the extent of myocardial scarring after myocardial infarction and has become the new gold standard for infarct size assessment in many randomized clinical trials. However, this imaging technique is not available at the bedside and may not be feasible in some patients.…”

Post-operative high sensitivity troponin T (hsTnT): toward an extending use for diagnosis and management of myocardial injury after noncardiac surgery?

“…In this subgroup of patients, hsTnT elevation was also statistically associated with cardiovascular death (17). After myocardial infarction, peak TnT elevation is strongly correlated with infarct size and left ventricular function at day 5 (R-value are respectively 0.702 and -0.394, P value <0.001) and day 30 (R-value are respectively 0.655 and -0.496, P value <0.001) (18). More recently, Hall and colleagues showed a strong and significant association between an elevation of troponin I (TnI) and cardiac events (cardiogenic shock, cardiac heart failure, arrhythmia) after ST-elevation myocardial infarction (19).…”

“…Elevation of hsTnT can help trialists to design clinical trials in challenging new therapeutics in the peri-operative context. Taking into considerations recent advances in cardiology (15)(16)(17)(18)(19), these future investigations must try to document pathophysiological mechanism involved in MINS and also patients reported outcomes after MINS. The MANAGE trial (Management of myocardial injury After NoncArdiac surGEry trial, clinicaltrial.gov, NCT01661101) will may be clarify the role of hsTnT during the postoperative period.…”

Updates on the Electrocardiogram in Acute Coronary Syndromes

“…In a different study by Kontos et al [21], of LBBB, there was an assessment of biomarker level (CK-MB) at 5 9 the upper limit of normal. In our retrospective study of LBBB [22 •• , 23-25] we required documented occlusion or a culprit lesion with a peak troponin I of at least 10 ng/ml, as most true STEMI have at least this level, and most true non-STEMI do not [26][27][28][29]. Until all ECG in ACS studies consistently assess ECG features of ischemia during proven occlusion, and contrast them to those who are proven not to have occlusion, we will make little progress on improving ECG recognition of this coronary event.…”