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Troponin ratio and risk stratification in subjects with acute coronary syndrome undergoing percutaneous coronary
Natale Daniele Brunetti1, Donato Quagliara, Matteo Di Biase
1Cardiology Department, University of Foggia, Foggia, Italy. dr.natale.daniele.brunetti@hotmail.it
Insights
The peak cardiac troponin I concentration/base concentration ratio (PBTR) effectively predicts major adverse cardiac events (MACEs) after percutaneous coronary intervention (PCI). This ratio is valuable for risk stratification, even when peak troponin levels are not significantly elevated.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Cardiac enzyme release post-PCI is crucial for risk stratification.
- Current risk stratification relies on CK-MB levels three times above the upper limit of normal (ULN).
- The utility of peak cardiac troponin I (cTn-I)/base concentration ratio (PBTR) as a predictor needs further evaluation.
Purpose of the Study:
- To assess if PBTR predicts major adverse cardiac events (MACEs) after PCI.
- To determine if PBTR is a useful predictor regardless of cTn-I ULN.
- To evaluate PBTR as a risk stratification tool in PCI patients.
Main Methods:
- 326 acute coronary syndrome patients undergoing PCI were studied.
- Serial cTn-I measurements were taken for at least 72 hours post-PCI.
- Patients were grouped by PBTR values (<1, 1-4, 4-10, >10) with 6-month MACEs follow-up.
Main Results:
- Higher PBTR values correlated with increased MACEs at 6 months (p<0.05).
- This correlation persisted in Q-wave MI and unstable angina subgroups.
- PBTR remained a significant predictor even with peak cTn-I < 3x ULN and after Cox regression analysis (HR 1.62, p<0.05).
Conclusions:
- PBTR is an independent predictor of 6-month MACEs post-PCI.
- PBTR serves as a valuable tool for adverse event prediction in PCI patients.
- This method aids risk stratification, especially when peak cTn-I levels are not markedly elevated.
Background:
Cardiac enzyme release after percutaneous coronary intervention (PCI) seems to play a role in risk stratification. After PCI, CK-MB plasmatic concentrations three times above the upper level of normal (ULN) are currently the most used risk stratification parameters. We sought to assess whether peak cardiac troponin I (cTn-I) concentration/base concentration ratio (PBTR) may act as a predictor of major adverse cardiac events (MACEs) after PCI, regardless of cTn-I ULN.
Methods:
We evaluated 326 consecutive patients with acute coronary syndrome (ACS) who underwent PCI. Baseline and post-PCI cTn-I values were evaluated over serial blood samples every 6h for at least 72h. Patients were further divided into four groups according to their PBTR values (<1, 1-4, 4-10, >10). MACEs were recorded over a 6-month follow-up period. Patients with primary PCI or unsuccessful PCI were excluded from the study.
Results:
Higher values of PBTR significantly correlated with a worse prognosis at 6 months (<1, 16.30% of MACEs; 1-4, 19.42%; 4-10, 24.39%; >10, 35.63%; p<0.05), both in Q-wave myocardial infarction (MI) and unstable angina (UA) subgroups. The correlation remained statistically significant, even considering subjects with peak cTn-I less than three times the ULN (p < 0.05) and after correction for age, gender, risk factors, diagnosis (MI versus UA), and peak cTn-I levels in a multiple Cox' regression analysis (HR 1.62, p<0.05).
Conclusions:
PBTR is an independent predictor of MACEs after PCI in a 6-month follow-up period. This risk stratification tool may be useful to predict adverse events in PCI patients, even in the case of apparently non-elevated peak cTn-I concentrations.
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