Defining the optimal cardiac troponin T threshold for predicting death caused by periprocedural myocardial infarction
Joerg Herrmann1, Ryan J Lennon1, Allan S Jaffe1
1From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George's, University of London, London, United Kingdom (A.P.).
Insights
Elevated cardiac troponin T (cTnT) after percutaneous coronary intervention indicates higher mortality risk. A threshold of 25x the upper limit of normal for cTnT predicts early mortality post-procedure.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Controversy exists regarding the diagnostic and prognostic significance of percutaneous coronary intervention (PCI)-related myocardial infarction, particularly concerning cardiac troponin T (cTnT) levels.
- The prognostic value of cTnT thresholds post-PCI requires clarification.
Purpose of the Study:
- To determine the presence and level of a prognostic threshold for cTnT following PCI.
- To assess the association between post-PCI cardiac biomarker elevation and early mortality.
Main Methods:
- Analysis of 5268 patients undergoing non-emergent PCI with preprocedural cTnT below the upper limit of normal (ULN).
- Evaluation of postprocedural cTnT and creatine kinase-MB mass levels in relation to 3-month mortality using Cox proportional hazard models.
- Adjustment for Mayo Clinic risk scores for in-hospital and postdischarge mortality.
Main Results:
- Postprocedural cTnT and creatine kinase-MB levels were associated with 3-month mortality.
- An optimal prognostic threshold for 3-month mortality was identified at 25x ULN for cTnT (HR, 4.53).
- This cTnT threshold provided similar prognostic information as a 5x ULN cutoff for creatine kinase-MB (HR, 4.31).
- Cumulative mortality rate at 91 days was 0.6%.
Conclusions:
- Post-PCI elevation of cardiac biomarkers, specifically cTnT, is significantly associated with early (91-day) outcomes.
- An optimal prognostic threshold for cTnT was identified at 25x ULN (0.25 ng/mL), offering comparable early outcome prediction to a 5x ULN cutoff for creatine kinase-MB.
Background:
There is controversy about the diagnostic and prognostic significance of percutaneous coronary intervention-related myocardial infarction, especially with the use of cardiac troponin T (cTnT). This analysis was designed to address the question of the presence and the level of a prognostic cTnT threshold.
Methods And Results:
We evaluated 5268 consecutive patients who underwent nonemergent percutaneous coronary intervention between 2000 and 2009 with a preprocedural cTnT level below the upper limit of normal (ULN, ≤0.01 ng/mL). Postprocedural cTnT and creatine kinase-MB mass levels (ULN, 6.7 ng/mL in men and 3.8 ng/mL in women) were found to be associated with 3-month mortality in Cox proportional hazard models (hazard ratio per doubling of cTnT, 1.24; 95% confidence interval, 1.08-1.43; P=0.003 and hazard ratio per doubling of creatine kinase-MB, 1.30; 95% confidence interval, 1.05-1.60; P=0.018), adjusted for the Mayo Clinic risk scores for in-hospital and postdischarge mortality. The optimal prognostic threshold for 3-month mortality was 25× ULN for cTnT (hazard ratio, 4.53; 99% confidence interval, 1.59-12.9; P<0.001), which provided similar information as a value of 5× ULN for creatine kinase-MB (hazard ratio, 4.31; 99% confidence interval, 1.27-14.6; P=0.002). The cumulative mortality rate was 0.6% at 91 days.
Conclusions:
A significant association of postpercutaneous coronary intervention cardiac biomarker elevation with a small number of postpercutaneous coronary intervention outcomes was noted for the early (first 91 days) follow-up period with an identifiable optimal threshold of 25× ULN (0.25, ng/mL) for cTnT, which provided similar early outcome information as a cutoff of 5× ULN for creatine kinase-MB.
More Related Videos
11:17A Microscopic 2,3,5-Triphenyltetrazolium Chloride Assay for Accurate and Reliable Analysis of Myocardial Injury
Published on: November 28, 2025
10:01Improvement of a Closed Chest Porcine Myocardial Infarction Model by Standardization of Tissue and Blood Sampling Procedures
Published on: March 12, 2018
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Cardiac Catheterization I: Pre-Procedure Overview