Aims
This study aimed to investigate the prognostic implications of increased postprocedural cardiac troponin levels in patients undergoing elective percutaneous coronary intervention (PCI) and to define the threshold of prognostically relevant periprocedural myocardial injury (PMI).
Methods and Reasults
A total of 3,249 patients with normal baseline troponin levels referred for elective PCI were enrolled and followed up for a median period of 20 months. The primary endpoint was major adverse cardiovascular events (MACEs) comprising all-cause death, myocardial injury (MI) and ischemic stroke. Post-PCI high-sensitivity cardiac troponin T (hs-cTnT) > 99% upper reference limit (URL) occurred in 78.3% of patients and did not increase the risk of MACEs (adjusted hazard ratio (adHR), 1.00, 95% confidence interval (CI), 0.58-1.74, p = 0.990). Nor did ‘major PMI’ defined as post-PCI hs-cTnT above 5 × URL (adHR, 1.30, 95% CI, 0.76-2.23, p = 0.340). Post-PCI troponin > 8 × URL, with an incidence of 15.2%, started to show an association with a higher risk of MACEs (adHR, 1.89, 95% CI, 1.06-3.37, p = 0.032), mainly driven by myocardial infarction (adHR, 2.38, 95% CI, 1.05-5.38, p = 0.037) and ischemic stroke (adHR 3.35, 95% CI, 1.17-9.64, p = 0.025).
Conclusions
In patients with normal baseline troponin values undergoing elective PCI, PMI defined as hs-cTnT > 8 × URL after PCI was more appropriate for identifying patients with an increased risk of MACEs, which may help guide clinical practice in this population.