Role of cardiac troponin T in the long-term risk stratification of patients undergoing percutaneous coronary intervention.
OBJECTIVE
To investigate the long-term prognostic significance of pre- and post-procedure troponin T (TnT) elevations in patients undergoing percutaneous coronary intervention (PCI).


RESULTS
TnT and CK-MB were measured pre- and post-procedure in 212 patients undergoing PCI. Major adverse events (composite of death, myocardial infarction and revascularization) were ascertained 6 years later. Pre-procedural TnT was a significant independent predictor of time to major events (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.16-2.64) and death or myocardial infarction. Post-procedural TnT elevation above normal was the only independent predictor of the primary end-point at 1 year (HR 2.39, 95% CI 1.09-5.26) but was not significantly related to event-free survival throughout follow-up. Post-PCI elevation of TnT 5x above normal, however, did significantly predict time to events during the entirety of follow-up. By contrast, CK-MB was not an independent predictor in any of the analyses.


CONCLUSIONS
Our study confirms the long-term prognostic value of pre-procedural TnT elevation in patients undergoing PCI, and demonstrates the superior predictive ability of a post-procedural increase in TnT 5x normal for long-term adverse events. Whether the prognostic significance of smaller post-procedural TnT elevations extends beyond the intermediate-term awaits further investigation.
Kizer
Jorge R
JR
Division of Cardiology, Department of Medicine and Public Health, Weill Medical College of Cornell University, New York, NY, USA.
Muttrej
Manoj R
MR
Matthai
William H
WH
McConnell
Joseph
J
Nardone
Heather
H
Sonel
Ali F
AF
Keane
Martin G
MG
Wilensky
Robert L
RL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood; D011379:Prognosis; D018570:Risk Assessment; D013577:Syndrome; D020107:Troponin T / Q000097:blood*
D007527:Isoenzymes; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form