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Prognostic significance of elevated troponin I after percutaneous coronary intervention
Warren J Cantor1, L Kristin Newby, Robert H Christenson
1Division of Cardiology, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B-1W8. cantorw@smh.toronto.on.ca.
Insights
Elevated cardiac troponin I (cTnI) after percutaneous coronary intervention (PCI) is common and indicates a higher risk of death or heart attack. This finding highlights cTnI as a valuable prognostic marker for patients with acute coronary syndromes undergoing PCI.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Elevated creatine kinase-MB (CK-MB) is a known prognostic indicator post-percutaneous coronary intervention (PCI).
- The prognostic significance of elevated cardiac troponin I (cTnI) after PCI remains uncertain.
Purpose of the Study:
- To determine the incidence of elevated cTnI following PCI.
- To assess the clinical significance and prognostic value of elevated cTnI in patients undergoing PCI.
Main Methods:
- Prospective substudy of the SYMPHONY trials involving 481 patients with acute coronary syndromes (ACS) undergoing PCI.
- Measurement of cTnI and CK-MB at multiple time points before and after PCI.
- Primary endpoint: 90-day incidence of death, myocardial infarction, or severe recurrent ischemia.
Main Results:
- Nearly half (48%) of patients exhibited elevated cTnI post-PCI, often associated with coronary stenting.
- Elevated cTnI correlated with a significantly higher risk of death or myocardial infarction (10.6% vs. 4.2%, p=0.005).
- Patients with cTnI positivity exclusively after PCI showed particularly worse outcomes, including increased mortality (5.2% vs. 0%, p=0.02).
Conclusions:
- Elevated cTnI is frequently observed after PCI in ACS patients and is linked to poorer 90-day clinical outcomes.
- Cardiac troponin I serves as a valuable prognostic indicator in this patient population.
- The findings support the routine monitoring of cTnI levels post-PCI for risk stratification.
Objectives:
We sought to assess the incidence and clinical significance of elevated cardiac troponin I (cTnI) after percutaneous coronary intervention (PCI).
Background:
Elevated creatine kinase-MB (CK-MB) is prognostically important after PCI, but the prognostic significance of elevated cTnI after PCI is uncertain.
Methods:
In a prospective substudy of the Sibrafiban Versus Aspirin to Yield Maximum Protection From Ischemic Heart Events Post-acute Coronary Syndromes (SYMPHONY) trials, which randomized patients with acute coronary syndromes (ACS) to receive aspirin or sibrafiban, we measured cTnI (positive, > or =1.5 ng/ml) and CK-MB (positive, > or =7 ng/ml) in 481 patients with PCI. Samples were collected immediately before and at 0, 8 and 16 h after PCI and analyzed by a core laboratory. The primary end point was the Kaplan-Meier estimate of death, myocardial infarction or severe, recurrent ischemia at 90 days.
Results:
Overall, 230 patients (48%) had elevated cTnI after PCI. Such patients underwent PCI sooner and were more likely to have coronary stenting. Elevated cTnI was associated with nonsignificantly higher risks of the primary end point (11.5% vs. 8.7%; p = 0.15) and of death (1.8% vs. 0.4%; p = 0.4) and a significantly higher risk of death or infarction (10.6% vs. 4.2%; p = 0.005). This pattern was more pronounced for patients who became positive only after PCI: primary end point, 20.7% vs. 10.1% for patients who remained negative after PCI (p = 0.05); death, 5.2% vs. 0% (p = 0.02); death or infarction, 18.1% vs. 4.1% (p = 0.007).
Conclusions:
Elevated cTnI, often observed after PCI in patients with ACS, is associated with worse 90-day clinical outcomes. This marker, therefore, is a useful prognostic indicator in such patients.