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Isolated elevation in troponin T after percutaneous coronary intervention is associated with higher long-term
Abhiram Prasad1, Mandeep Singh, Amir Lerman
1Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. prasad.abhiram@mayo.edu
Insights
An isolated rise in cardiac troponin T (cTnT) after percutaneous coronary intervention (PCI), even with normal creatine kinase-MB (CK-MB), predicts poorer long-term survival and increased risk of myocardial infarction.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Outcomes
Background:
- Cardiac troponin T (cTnT) is a specific marker for heart muscle damage.
- The prognostic value of isolated cTnT elevation post-PCI, without concurrent CK-MB rise, is not well understood.
Purpose of the Study:
- To determine if an isolated elevation in cTnT, with normal CK-MB, predicts long-term survival after PCI.
- To investigate the prognostic significance of minor cTnT elevations post-procedure.
Main Methods:
- Analysis of 1,949 patients undergoing non-emergency PCI with normal pre- and post-procedure cTnT and CK-MB.
- Evaluation of clinical outcomes, including mortality and myocardial infarction, over a median follow-up of 26 months.
Main Results:
- 19.6% of patients had an elevated cTnT (cTnT+) post-PCI.
- cTnT+ patients had higher mortality (p < 0.001) and combined death/myocardial infarction rates (p = 0.004).
- Elevated cTnT was an independent predictor of long-term mortality, with an 86.9% 3-year survival rate compared to 93.2% in cTnT-negative patients.
Conclusions:
- Isolated minor cTnT elevation after PCI is a significant predictor of long-term mortality.
- This finding provides valuable prognostic information for patients undergoing PCI.
Objectives:
The aim of this study was to evaluate whether, in patients with normal post-procedure CK-MB, an isolated elevation in cardiac troponin T (cTnT) predicts long-term survival.
Background:
Cardiac troponin T is a sensitive and specific marker of myonecrosis. There is little known about the incidence and prognostic significance of an isolated elevation of cTnT without a rise in creatine kinase (CK)-MB following PCI.
Methods:
We evaluated the outcomes of 1,949 patients from the Mayo Clinic registry who had normal pre-procedure cTnT and CK-MB, required nonemergency percutaneous coronary intervention (PCI), and had normal CK-MB after the procedure.
Results:
An elevation in cTnT (cTnT+) was observed in 383 patients (19.6%) (median 0.04 ng/ml, interquartile range 0.03 to 0.06 ng/ml). The TnT+ status was associated with adverse clinical and angiographic characteristics, and multivessel PCI. Over the median follow-up duration of 26 months, mortality (p < 0.001) and the combined rate of death and myocardial infarction (p = 0.004) were significantly higher in cTnT+ patients. Estimated 3-year survival for those with and without cTnT elevation was 86.9% and 93.2%, respectively. By multivariate analysis, an elevation in cTnT after PCI was an independent predictor of increased long-term mortality. A doubling in the post-PCI cTnT was associated with a partial hazard ratio of 1.20 (95% confidence interval 1.02 to 1.40; p = 0.023).
Conclusions:
An isolated minor elevation in cTnT after PCI provides long-term prognostic information regarding mortality and myocardial infarction.
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