title: Isolated elevation in troponin T after percutaneous coronary intervention is associated with higher long-term mortality.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether, in patients with normal post-procedure CK-MB, an isolated elevation in cardiac troponin T (cTnT) predicts long-term survival.
  
  
  BACKGROUND
  Cardiac troponin T is a sensitive and specific marker of myonecrosis. There is little known about the incidence and prognostic significance of an isolated elevation of cTnT without a rise in creatine kinase (CK)-MB following PCI.
  
  
  METHODS
  We evaluated the outcomes of 1,949 patients from the Mayo Clinic registry who had normal pre-procedure cTnT and CK-MB, required nonemergency percutaneous coronary intervention (PCI), and had normal CK-MB after the procedure.
  
  
  RESULTS
  An elevation in cTnT (cTnT+) was observed in 383 patients (19.6%) (median 0.04 ng/ml, interquartile range 0.03 to 0.06 ng/ml). The TnT+ status was associated with adverse clinical and angiographic characteristics, and multivessel PCI. Over the median follow-up duration of 26 months, mortality (p < 0.001) and the combined rate of death and myocardial infarction (p = 0.004) were significantly higher in cTnT+ patients. Estimated 3-year survival for those with and without cTnT elevation was 86.9% and 93.2%, respectively. By multivariate analysis, an elevation in cTnT after PCI was an independent predictor of increased long-term mortality. A doubling in the post-PCI cTnT was associated with a partial hazard ratio of 1.20 (95% confidence interval 1.02 to 1.40; p = 0.023).
  
  
  CONCLUSIONS
  An isolated minor elevation in cTnT after PCI provides long-term prognostic information regarding mortality and myocardial infarction.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. prasad.abhiram@mayo.edu
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013995:Time; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T