BRIEF OBSERVATION Prognostic Value of Megatroponinemia After Myocardial Infarction Nishant Kalra, MD, Sudhakar Sattur, MD, MHSA, Vincent L. Sorrell, MD Sarver Heart Center, University of Arizona, Tucson. ABSTRACT PURPOSE: The purpose of this study is to investigate the prognostic value of megatroponinemia (troponins 100 ng/mL), as a predictor of major adverse cardiac events such as recurrent angina, myocardial infarction, and death in patients presenting with acute myocardial infarction. METHODS: Over a period of 2 years, we identified 27 patients admitted with acute myocardial infarction and troponin I values 100 ng/mL. These patients were followed-up for the short term during their hospitalization as well as for an intermediate term of 18  14 months after their initial presentation with acute myocardial infarction for major adverse cardiac events including recurrent angina, myocardial infarction, and death. RESULTS: Of the 27 patients, one died 5 days after myocardial infarction and 26 were discharged home in stable condition, with few requiring timely intervention. Six patients were lost to follow-up. Five patients died during follow-up, 4 from recurrent myocardial infarction and 1 died from metastatic renal cell carcinoma. Twelve patients had non-fatal myocardial infarction, with 10 being acute ST elevation; 3 patients had recurrent angina. CONCLUSION: Patients presenting with an acute myocardial infarction and troponins 100 ng/mL have continued incremental risk of excessive major adverse cardiac events during short and intermediate follow-up period. © 2009 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2009) 122, 392-394 KEYWORDS: Acute myocardial infarction; Megatroponinemia; Prognosis; Troponin Cardiac-specific troponins (T and I) are sensitive biochem- ical markers for myocardial necrosis. 1,2 The Thrombolysis in Myocardial Infarction IIIB trial, a prospective, random- ized, multicenter study of patients with unstable angina or non-Q-wave myocardial infarction, has shown a statistically significant increase in mortality with increasing level of cardiac troponin I (0.4 ng/mL) after adjustment for the baseline characteristics. 3 However, to our knowledge, there are no data on the prognostic value of very high troponin levels (100 ng/mL) after acute myocardial infarction. The purpose of this study is to investigate the prognostic value of megatroponinemia (troponins 100 ng/mL) as a predic- tor of major adverse cardiac events such as recurrent angina, myocardial infarction, and death in patients presenting with acute myocardial infarction. METHODS Over a period of 2 years, we identified 27 patients admitted with acute myocardial infarction and troponin I values 100 ng/mL. Troponin I was checked using a Bayer Advia Centaur Troponin I assay (Tarrytown, NY). These patients were followed for 18  14 months after their initial presenta- tion with an acute myocardial infarction. Major adverse car- diac events were recorded. Follow-up was performed by chart review and patient representative contact when necessary. The protocol was approved by the Institutional Review Board of Brody School of Medicine, Greenville, North Carolina. RESULTS Patient baseline and angiographic characteristics are shown in Tables 1 and 2. One patient did not have a ventriculogram Funding: None. Conflict of Interest: None. Authorship: All authors had access to the data and a role in writing the manuscript. Requests for reprints should be addressed to Nishant Kalra, MD, Cardiovascular Imaging, Sarver Heart Center, University of Arizona, Tuc- son, AZ 85712. E-mail address: nkalra_dr@yahoo.com 0002-9343/$ -see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.amjmed.2008.11.024