Predictors of postprocedural troponin increase in patients undergoing elective percutaneous coronary intervention

Elevation in serum troponin following elective percutaneous coronary intervention (PCI) is indicative of post-PCI troponin increase (pTI) and is associated with higher mortality rates. In this analysis, we sought to identify clinical and angiographic risk factors for pTI.

Consecutive patients undergoing elective PCI with drug-eluting stent implantation at Mount Sinai Hospital, New York, USA, between 2012 and 2022 were retrospectively analysed. Patients with elevated baseline troponin (>1× upper reference limit (URL)) and missing baseline or post-PCI troponin values were excluded. pTI was defined according to the cut-offs established by the Fourth Universal Definition of Myocardial Infarction (UDMI, ≥5× URL) and the Academic Research Consortium 2 (ARC-2) definition (≥35× URL). Predictors of pTI were evaluated through multivariable logistic regression with stepwise selection of candidate covariates.

Of the 10 592 included patients, 16.3% had pTI by UDMI criteria and 4.4% by ARC-2 criteria. Predictors of pTI for both definitions included low-density lipoprotein cholesterol, lesion length and maximum stent diameter, while higher left ventricular ejection fraction, prior PCI and intravascular imaging use had a protective effect. Female sex, anaemia and P2Y12 inhibitor loading (as opposed to chronic therapy) predicted UDMI-defined pTI but not ARC-2-defined pTI, whereas chronic kidney disease predicted only ARC-2-defined pTI.

In conclusion, there are patient-specific angiographic and clinical risk factors that can predict pTI. These risk factors should be considered in formulating more individualised risk assessment for those undergoing elective PCI.