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Routine cardiac troponin assessment after percutaneous coronary intervention: useful or hype?
Giuseppe Lippi1, Camilla Mattiuzzi2, Fabian Sanchis-Gomar3,4
1Section of Clinical Biochemistry, University of Verona, Verona.
Insights
Routine cardiac troponin (cTn) assessment after percutaneous coronary intervention (PCI) is often elevated but may not predict adverse outcomes. Reserve serial cTn testing for high-risk patients with symptoms or ECG changes post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Percutaneous coronary intervention (PCI) has high success rates but can lead to complications like periprocedural myocardial infarction (MI).
- Accurate diagnosis of periprocedural MI is crucial for tailored patient management.
- The clinical significance of routine cardiac troponin (cTn) assessment post-PCI remains uncertain.
Purpose of the Study:
- To evaluate the clinical and prognostic significance of routine cardiac troponin (cTn) assessment following percutaneous coronary intervention (PCI).
- To determine the utility of current diagnostic criteria for periprocedural myocardial infarction (MI).
Main Methods:
- Review of current scientific evidence regarding periprocedural myocardial infarction (MI) diagnosis.
- Analysis of the prognostic value of elevated cardiac troponin (cTn) levels after PCI.
Main Results:
- Elevated periprocedural cardiac troponin (cTn) levels occur in 30-90% of patients undergoing PCI.
- Isolated biochemical evidence of myocardial injury post-PCI does not consistently predict adverse clinical outcomes or mortality.
- Current data suggests routine serial cTn assessment is not warranted for all PCI patients.
Conclusions:
- Routine serial cardiac troponin (cTn) assessment after percutaneous coronary intervention (PCI) is not recommended.
- Serial cTn testing should be reserved for high-risk PCI patients presenting with new ECG changes or ischemic symptoms.
- An isolated rise in cTn post-PCI requires careful clinical correlation rather than immediate classification as MI.
Abstract:
: Although the angiographic and procedural success of percutaneous coronary intervention (PCI) is now very high, some severe complications may still develop, including periprocedural myocardial infarction (MI). An accurate diagnosis of this condition is essential for guiding the clinical management, as these patients may need a tailored management. The current recommendations for diagnosing periprocedural myocardial infarction based on the fourth universal definition appear at first sight straightforward, but the clinical and prognostic significance of routine periprocedural cardiac troponin (cTn) assessment remains uncertain. The current scientific evidence suggests that the likelihood of observing increased periprocedural values of cTn is high, comprising between 30 and 90%. Moreover, cTn values after PCI do not straightforwardly predict major adverse cardiovascular events or all-cause mortality. Although it seems still premature to classify many cases as 'false positive' periprocedural MIs, it is now clear that an isolate 'biochemical diagnosis' of myocardial injury during or immediately after PCI does not translate into early unfavourable clinical consequences. At this point in time, it seems reasonable to suggest that serial cTn assessment should not be routinely performed, but should be reserved for a high-risk subset of PCI patients who have also developed new ECG changes or symptoms suggestive of myocardial ischemia.
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