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Published on: January 28, 2020
Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary
Hector M Garcia-Garcia1, Eugène P McFadden2, Clemens von Birgelen3
1Cardialysis, Rotterdam, the Netherlands; Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Insights
Biomarker elevation after percutaneous coronary intervention (PCI) is common. Creatine kinase-myocardial band (CK-MB) elevation, but not cardiac troponin (cTn), was linked to increased mortality in stable angina patients post-PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarker Research
Background:
- Previous studies indicate a strong link between post-PCI CK-MB elevation and mortality.
- The prognostic value of troponin elevation after coronary intervention remains debated.
- Stable angina patients with normal baseline biomarkers are the focus.
Purpose of the Study:
- To investigate the association between post-PCI biomarker elevation (CK-MB or cTn) and mortality.
- To compare mortality rates in patients with and without specific biomarker cutoff values following PCI.
Main Methods:
- Pooled patient-level data from 5 contemporary coronary stent trials and 1 large registry.
- Analysis included 13,452 patients with stable angina and normal baseline biomarkers.
- Mortality was compared between patients with and without elevated CK-MB and cTn post-PCI.
Main Results:
- Overall biomarker elevation post-PCI: 23.9% for CK-MB and 68.4% for cTn.
- At 1 year, 1.9% of patients died; 7.7% of deaths had CK-MB ≥5x ULN, 8.8% had cTn ≥35x ULN.
- Multivariate analysis identified CK-MB ratio (≥10) post-procedure as associated with increased 1-year mortality.
Conclusions:
- CK-MB and cTn elevations are common after elective PCI with drug-eluting stents in stable patients.
- Elevated CK-MB post-PCI is independently associated with increased 1-year mortality.
- Elevated cTn post-PCI was not independently associated with 1-year mortality in this cohort.
Objectives:
This study sought to explore the association between biomarker elevation, with creatine kinase-myocardial band (CK-MB) or cardiac troponin (cTn), following percutaneous coronary intervention (PCI) and mortality in patients undergoing PCI for stable angina with normal baseline values.
Background:
Several studies have shown a strong association between post-PCI CK-MB elevation and subsequent mortality. However, the prognostic significance of troponin elevation following coronary intervention is still debated.
Methods:
Patient-level data from 5 contemporary coronary stent trials and 1 large registry were pooled. Mortality of patients with stable angina, with normal baseline biomarkers, was compared between patients with and those without different cutoff values of cTn and CK-MB.
Results:
A total of 13,452 patients were included in this pooled analysis. The overall percentage of patients with elevated biomarkers following PCI was 23.9% for CK-MB and 68.4% for cTn. In the patient cohort for whom both assays were available (n = 8,859), 2.4% had both CK-MB ≥5 × the upper limit of normal (ULN) and cTn ≥35 × ULN, while 92% had both CK-MB <5 × ULN and cTn <35 × ULN. Among patients with CK-MB ≥5 × ULN (n = 315), 212 (67.3%) also had cTn ≥35 × ULN. Conversely, 390 of patients (64.8%) who had cTn ≥35 × ULN did not have CK-MB ≥5 × ULN. A total of 259 patients (1.9%) died at 1 year; 20 (7.7%) had CK-MB ≥5 × ULN, and 23 (8.8%) had cTn ≥35 × ULN. In the Cox multivariate analysis, in which the CK-MB and cTn ratios post-procedure were forced into the model, age, prior myocardial infarction, lesion complexity, hyperlipidemia, and CK-MB ratio (≥10) post-procedure were associated with increased 1-year mortality.
Conclusions:
Following elective PCI in patients in stable condition treated with second-generation drug-eluting stent, CK-MB and cTn elevations remain common. After multivariate adjustment, there was an increased mortality rate with elevation of CK-MB after PCI, whereas cTn elevation was not independently associated with mortality at 1 year.
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