High-Sensitivity Troponin T and Mortality After Elective PCI

Study Questions:

What is the prognostic value of post-procedural high-sensitivity troponin T (hs-TnT) following elective percutaneous coronary intervention (PCI)?

Methods:

This study included 5,626 patients undergoing elective PCI who had baseline and peak post-procedural hs-TnT measurements available. The primary outcome was 3-year mortality (with risk estimates calculated per standard deviation increase of the log hs-TnT scale).

Results:

Patients were divided into four groups: with nonelevated baseline and post-procedural hs-TnT (hs-TnT ≤0.014 μg/L; 742 patients); with nonelevated baseline, but elevated post-procedural hs-TnT (peak post-procedural hs-TnT >0.014 μg/L; 2,721 patients); with elevated baseline hs-TnT (hs-TnT >0.014 μg/L) without a further rise post-procedure (516 patients); and with elevated baseline hs-TnT with a further rise post-procedure (1,647 patients). There were 265 deaths: six (1.6%) in patients with nonelevated baseline and post-procedural hs-TnT; 54 (3.8%) in patients with nonelevated baseline, but elevated post-procedural hs-TnT; 50 (16.0%) in patients with elevated baseline hs-TnT without a further rise post-procedure; and 155 (18.2%) in patients with elevated baseline hs-TnT with a further rise post-procedure (p < 0.001). After adjustment, baseline (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.09-1.38; p < 0.001), but not peak post-procedural hs-TnT (HR, 1.04; 95% CI, 0.85-1.28; p = 0.679) was associated with the increased risk of mortality. Peak post-procedural hs-TnT was not associated with mortality in patients with nonelevated (HR, 0.93; 95% CI, 0.69-1.25; p = 0.653) or elevated (HR, 1.24; 95% CI, 0.91-1.69; p = 0.165) baseline hs-TnT.

Conclusions:

The authors concluded that in patients with coronary artery disease undergoing elective PCI, a rise in postprocedural hs-TnT did not provide prognostic information beyond that provided by the baseline level of the biomarker.

Perspective:

This study reports that in patients with coronary artery disease undergoing elective PCI, a procedure-related hs-TnT rise occurred in the majority of patients, but this elevation was not associated with an increased risk of mortality for up to 3 years, regardless of the preprocedural hs-TnT level. It appears that PCI-related hs-TnT elevation does not provide prognostic information beyond that provided by baseline hs-TnT levels. Overall, the study findings support the definition of clinically relevant myocardial infarction after coronary revascularization in the Consensus Document of the Society of Cardiovascular Angiography and Interventions at ≥70 times the local laboratory upper limit of normal (ULN), or ≥35 times ULN with new pathologic Q waves in ≥2 contiguous leads.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, ACS and Cardiac Biomarkers, Aortic Surgery, Interventions and ACS, Interventions and Coronary Artery Disease

Keywords: Acute Coronary Syndrome, Biological Markers, Coronary Artery Disease, Mortality, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Troponin T


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