Frequency, Risk Factors, and Effect on Long‐Term Survival of Increased Troponin I Following Uncomplicated Elective Percutaneous Coronary Intervention

Abstract

Background: The frequency, risk factors for, and effect on long-term survival of increased troponin I (cTnI) following elective, uncomplicated percutaneous coronary intervention (PCI) remains uncertain. Methods: We studied 907 patients undergoing elective PCI without recognized PCI complications and with at least 1 measurement of cTnI 12 or more h following the procedure. Patients with pre-PCI cTnI above 0.1 ng/ml or with myocardial infarction within the previous 48 h were excluded. Results: Maximal cTnI (TrMX) following PCI averaged 0.8 ng/ml, exceeded the upper normal of 0.1 ng/ml in 65.2% of patients and was 1.5 ng/ml or above in 13.7%. Of several demographic and procedural variables examined, the only significant predictor of TrMX was the number of stents deployed. (p<0.0023 95% confidence interval [CI]: 0.10-0.46). Significant univariate predictors of survival (Kaplan-Meier) were older age (p<0.0001), diabetes (p = 0.02), peripheral vascular disease (p<0.0001), obstructive lung disease (p<0.0001), congestive failure (p<0.0001), renal impairment (p<0.0001), and TrMX of 3.62 ng/ml or above (p = 0.0451). Independent predictors (Cox) were older age (p<0.0001), obstructive lung disease (p<0.0001), congestive failure (p<0.0001), and TrMX (p = 0.0272). Conclusions: Elevation of cTnI occurs in most patients undergoing elective, uncomplicated PCI. Deployment of multiple stents is associated with higher values of cTnI. Long-term survival is primarily influenced by age and pre-PCI comorbidities, however patients with the highest values of cTnI after PCI are also at increased risk of reduced survival. Significant independent predictors of reduced survival were older age, obstructive pulmonary disease, congestive failure (p<0.0001 for each), and maximal post-PCI cTnI (p = 0.0272).

Outcomes of non–acute coronary syndrome patients discharged from the emergency department with troponin positivity

“…An explicit chart review was undertaken to determine if patients had a history of myocardial infarction or cardiac procedure (percutaneous coronary intervention, coronary artery bypass graft, cardiac ablation, or pacemaker or implantable cardioverter-defibrillator insertion) during the previous month; these patients were excluded due to potential spurious troponin elevation. 15,20,21 At both EDs, the approach to potentially ischemic chest pain is set by protocol. Myocardial infarction is defined, in a manner consistent with the universal definition of myocardial infarction, 22 as a troponin elevation greater than the 99th percentile of the upper reference limit with a greater than 20% change between serial measurements, or troponin elevation with electrocardiographic (ECG) changes in keeping with myocardial infarction.…”

The number of red blood cell-derived microparticles in predicting periprocedural adverse effects in acute STsegment elevation myocardial infarction patients

“…Although there is a large body of evidence regarding utility of biomarkers of cardiac injury in predicting myocardial functional recovery [3][4][5], the prognostic information of commonly used cardiac biomarkers (i.e., troponins, creatine kinase-myocardial band isoenzymes (CK-MB), and their combinations) regarding mortality rate is still controversial [6][7][8]. Indeed, troponin I is an highly sensitive marker of myocardial necrosis or even very minor reversible myocardial injury caused by Percutaneous Coronary Intervention (PCI), which did not influence the death rate [9].…”

Utility of the Red Blood Cell-Derived Microparticles as a Marker of Periprocedural Adverse Effects amongst Patients with Acute ST-Segment Elevation Myocardial Infarction

“…Microvascular obstruction has remained a prognostic importance for short-term and long-term periprocedural survival after acute STsegment elevation myocardial infarction (STEMI) [1,2]. Although there is a large body of evidence regarding utility of biomarkers of cardiac injury in predicting myocardial functional recovery [3][4][5], the prognostic information of commonly used cardiac biomarkers (i.e., troponins, creatine kinase-myocardial band isoenzymes, and their combinations) regarding mortality rate is still controversial [6][7][8]. Indeed, troponin I is an highly sensitive marker of myocardial necrosis or even very minor reversible myocardial injury caused by percutaneous coronary intervention (PCI), which did not influence the death rate [9].…”