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Published on: January 28, 2020
Prognostic value of troponin after elective percutaneous coronary intervention: A meta-analysis
Mark B Nienhuis1, Jan Paul Ottervanger, Henk J G Bilo
1Department of Cardiology, Isala klinieken, Zwolle, The Netherlands.
Insights
Troponin elevation after percutaneous coronary intervention (PCI) indicates higher mortality risk. This meta-analysis confirms troponin levels post-PCI provide significant prognostic information for patient outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- The prognostic value of troponin in acute coronary syndromes is established.
- The significance of troponin elevation following elective percutaneous coronary intervention (PCI) remains debated.
- Previous studies lacked sufficient sample size and follow-up events.
Purpose of the Study:
- To investigate the prognostic significance of troponin elevation after elective PCI.
- To determine the association between post-PCI troponin levels and patient outcomes.
Main Methods:
- A meta-analysis of 20 studies involving 15,581 patients.
- Searches included electronic and manual retrieval of relevant studies.
- Primary endpoint was all-cause mortality; secondary endpoint was death or nonfatal myocardial infarction.
Main Results:
- Troponin elevation occurred in 32.9% of patients post-elective PCI.
- Elevated troponin was significantly associated with increased mortality (OR 1.35, P = 0.001).
- Elevated troponin also correlated with a higher incidence of death or nonfatal myocardial infarction (OR 1.59, P < 0.001).
Conclusions:
- Troponin elevation after elective PCI is a significant prognostic indicator.
- Post-procedural troponin levels offer valuable information for risk stratification.
Background:
Although the prognostic importance of troponin in patients with anacute coronary syndrome is clear, the significance of troponin elevation after elective percutaneous coronary intervention (PCI) is a subject of debate. However, most studies up to now had a small sample size and insufficient events during follow-up.
Methods:
Electronic and manual searches were performed of studies reporting on prognosis of troponin after elective PCI. A meta-analysis was done of all suitable studies, with death in follow-up as primary endpoint and the combination of death or nonfatal myocardial infarction in follow-up as secondary endpoint.
Results:
20 studies involving 15,581 patients were included. These studies were published between 1998 and 2007. Overall, troponin was elevated after elective PCI in 32.9% of patients. The follow-up period varied between 3 and 67 months (mean 16.3). Increased mortality was significantly associated with troponin elevation after PCI (4.4% vs. 3.3%, P = 0.001; OR 1.35). Furthermore, the combined endpoint of mortality or nonfatal myocardial infarction also occurred more often in patients with post-procedural troponin elevation (8.1% vs. 5.2%, P < 0.001; OR 1.59).
Conclusions:
According to this meta-analysis, troponin elevation after elective PCI provides important prognostic information.
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