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Post-procedural elevated cardiac troponin I and the association with 5-year mortality in patients undergoing elective
Queyun Sun1, Pei Zhu1, Jingjing Xu1
1Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, A 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
Insights
A post-procedural cardiac troponin I level 70 times the upper reference limit independently predicts 5-year mortality after elective percutaneous coronary intervention. This threshold, defined by SCAI 2014, is crucial for assessing long-term prognosis in these patients.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- The prognostic significance of cardiac troponin I (cTnI) thresholds post-percutaneous coronary intervention (PCI) remains debated.
- Establishing a clinically meaningful cTnI threshold is vital for long-term patient outcomes.
Purpose of the Study:
- To evaluate the association between various post-procedural cTnI levels and 5-year mortality.
- To identify a specific cTnI threshold predictive of long-term prognosis after elective PCI.
Main Methods:
- Analysis of 4059 patients with normal baseline cTnI undergoing elective PCI.
- Measurement of post-procedural cTnI levels between 8-48 hours after PCI.
- Assessment of 5-year all-cause and cardiovascular mortality as primary endpoints.
Main Results:
- A post-procedural cTnI ≥70 times the upper reference limit (URL) independently predicted 5-year all-cause and cardiovascular mortality.
- Higher peak cTnI levels correlated with increased mortality rates.
- The Society for Cardiovascular Angiography and Interventions (SCAI) 2014 threshold (≥70x URL) showed significant association with mortality.
Conclusions:
- A post-procedural cTnI level ≥70x URL is an independent predictor of 5-year mortality in patients undergoing elective PCI.
- The SCAI 2014 cTnI threshold is the most relevant for assessing long-term mortality risk in this population.
Background:
The clinically meaningful cardiac troponin I (cTnI) threshold associated with the long-term prognosis in patients undergoing elective percutaneous coronary intervention (PCI) is still debated.
Objective:
To assess the association between different thresholds for post-procedural cTnI and 5-year mortality.
Methods:
The study included 4059 consecutive patients with normal baseline cTnI values who underwent elective PCI. The post-procedural cTnI level was measured at 8-48 h after PCI. The main study endpoints were 5-year all-cause mortality and cardiovascular mortality.
Results:
A cTnI ≥5 times the upper reference limit (URL) as defined by the fourth universal definition of myocardial infarction (4th UDMI), ≥35 times as defined by the Academic Research Consortium-2 criteria, and ≥70 times as defined by the Society for Cardiovascular Angiography and Interventions (SCAI [2014]) was identified in 33%, 6.6%, and 3.3% of patients, respectively. During 5 years of follow-up, the all-cause mortality rate was 3.4% (n = 132) and the cardiovascular mortality rate was 2.0% (n = 77). Both all-cause mortality and cardiovascular mortality increased with higher peak cTnI, and were independently predicted by a cTnI ≥70 times the URL (adjusted hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.20-5.02 and adjusted HR 3.17, 95% CI 1.31-7.67, respectively; reference, cTnI <1 × URL]. The SCAI (2014) threshold was significantly associated with 5-year cardiovascular mortality (adjusted HR 2.66, 95% CI 1.20-5.89; reference, cTnI, <70 × URL) and all-cause mortality (adjusted HR 2.23, 95% CI 1.16-4.30; reference, cTnI <70 × URL).
Conclusion:
In patients with normal pre-procedural cTnI who underwent elective PCI, a post-procedural cTnI ≥70 times the URL independently predicted 5-year all-cause and cardiovascular mortality. Therefore, only the SCAI (2014) post-procedural cTnI threshold was independently associated with long-term mortality.
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