Prognostic significance of preprocedural troponin-I in patients with non-ST elevation acute coronary syndromes undergoing percutaneous coronary intervention.
OBJECTIVE
Cardiac troponin elevation has been shown to be associated with adverse outcomes after percutaneous coronary intervention (PCI) for various subgroups of coronary artery disease. We sought to determine the prognostic significance of cardiac troponin I (cTnI) in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) treated with PCI.


METHODS
The study consisted of 760 consecutive patients undergoing PCI for NSTE-ACS. Levels of cTnI were obtained repeatedly every 6 h before PCI. Peak cTnI levels were used for analysis. Patients were followed for major adverse cardiac events (MACE) defined as death, myocardial infarction, and urgent target vessel revascularization for a mean follow-up of 2.9 years.


RESULTS
Patients with normal cTnI levels (<or=1.0 ng/ml) were classified into subgroup 1. The remaining patients were divided based on an optimal cut-off value derived from the receiver operating characteristic analysis into subgroups 2 (1.1-20 ng/ml) and 3 (>20 ng/ml). By multivariate analyses, patients with higher peak preprocedural cTnI levels were independently associated with increased risk of 30-day mortality [adjusted odds ratio, 1.88, 95% confidence interval (CI): 1.11-3.17, P=0.019] and composite MACE [group 1 vs. group 2 (adjusted hazard ratio 2.09, 95% CI: 1.35-3.23, P<0.001), group 1 vs. group 3 (adjusted hazard ratio 3.64, 95% CI: 2.39-5.56, P<0.001)].


CONCLUSIONS
Preprocedural cTnI level is a strong and independent predictor of 30-day mortality and long-term MACE after PCI in the setting of NSTE-ACS.
Napan
Sirikarn
S
Division of Cardiology, Department of Internal Medicine, Howard University Hospital, Washington, DC 20060, USA. snapan@howard.edu
Kashinath
Ramesh Chillal
RC
Kadri
Sameer
S
Orig
Maria N
MN
Khadra
Suhail
S
D054058:Acute Coronary Syndrome / Q000097:blood / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D015854:Up-Regulation
D015415:Biomarkers; D019210:Troponin I