Second peak of myocardial markers predicts in-hospital adverse outcomes after primary PCI for ST-segment elevation myocardial infarction

Abstract

Background A second peak of high-sensitivity cardiac troponin T (hs-cTnT) after reperfusion therapy in acute myocardial infarction (AMI) patients was reported, while the causes and clinical meanings remain controversial. Methods In this retrospective study, we enrolled patients diagnosed with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). The association between second peak of myocardial markers, including creatine kinase-MB (CK-MB) and hs-cTnT and clinical outcomes, D-dimer (D-D), cardiac structure and function were analyzed. The main study outcome was in-hospital major adverse cardiovascular events (MACE), including cardiac death, non-fatal AMI, revascularization and stroke. Results A total of 264 patients were included in the study, with an average age of 63 ± 12 years. Of these, 220 were male. Second peak of cardiac markers including hs-cTnT and CK-MB of STEMI patients after PPCI was universal: The proportion of STEMI patients with secondary elevation of cardiac troponin T (cTnT) was 62.8%, while CK-MB 28.8%. Maximum D-D during hospitalization independently predicted second myocardial markers elevation. STEMI patients with second cardiac markers elevation after PPCI had a worse in-hospital composite endpoint. Conclusions D-D was an independent predictor of secondary cardiac markers elevation in STEMI patients after PPCI. Patients with second peak of cardiac markers had a worse outcome.