Torrent of Troponin

White, Harvey D.

doi:10.1161/circinterventions.114.001751

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…3 In the context of percutaneous coronary interventions (PCI), the magnitude of postprocedural biomarker elevation reflecting clinically relevant myocardial damage remains controversial. 4 The Society for Cardiovascular Angiography and Interventions (SCAI) proposed a definition of periprocedural myocardial infarction (PMI) 5 which, compared with previous definitions, 6 entails substantially higher creatine kinase-myocardial band fraction (CK-MB) or cTn levels-presumably corresponding to myocardial injury large enough to have clinical consequences. The SCAI threshold of CK-MB elevation was based on previous evidence linking these levels to adverse post-PCI outcomes, 7 and the prognostic impact of this CK-MBbased definition was prospectively validated in subsequent investigations.…”

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confidence: 99%

Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions

Koskinas

Ndrepepa

Räber

et al. 2018

Circ: Cardiovascular Interventions

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BACKGROUND:The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions. METHODS AND RESULTS:We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT >70× upper reference limit (URL) in patients with nonelevated (≤1× URL) baseline levels; or incremental increase >70× URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n=140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51-6.68; P<0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50-7.11; P<0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was >10×URL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin. CONCLUSIONS:In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10× URL) in this cohort.

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confidence: 99%

Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions

Koskinas

Ndrepepa

Räber

et al. 2018

Circ: Cardiovascular Interventions

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“…Given the variability in reference ranges for current troponin assays, White suggests that it may not be possible to defi ne a particular threshold that could be applied to all [ 7 ].…”

Section: Defi Nition Of MImentioning

confidence: 99%

Circulating Cardiac Troponins as Specific Biomarkers of Myocardial Damage: Clinical Considerations

Hicks

2015

Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Cardiac troponin (cTn) is one of the most widely used biomarkers in clinical care and biomedical research. Compared to the MB fraction of creatine kinase (CK-MB), cTn is the preferred biomarker for detecting myocardial necrosis because of its high myocardial tissue specifi city and high clinical sensitivity. Although an elevated cTn value refl ects injury leading to myocardial necrosis, the underlying mechanism may be diffi cult to ascertain. Such mechanisms may be ischemic, nonischemic, or analytical in origin and can only be determined by considering the clinical context in which the measurement is made.The chapter discusses a general approach to the clinical interpretation of cTn elevation and how an acute myocardial infarction may be differentiated from other etiologies.

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Torrent of Troponin

Cited by 2 publications

References 23 publications

Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions

Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions

Circulating Cardiac Troponins as Specific Biomarkers of Myocardial Damage: Clinical Considerations

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