title: Cardiac biomarker measurement after elective percutaneous coronary interventions in older patients: insights from the National Cardiovascular Data Registry.
abstract: BACKGROUND
  Guidelines recommend consideration of cardiac biomarker measurement after elective percutaneous coronary intervention (PCI), especially with complex cases or complicated procedures. However, the long-term prognostic implications of biomarker measurement after elective PCI have not been well characterized in older patients.
  
  
  METHODS
  We examined 157,825 Medicare patients undergoing elective PCI in the United States from 2004 to 2008 at 711 hospitals in the CathPCI Registry. Clinical characteristics and 1-year mortality risk were studied, stratified by creatine kinase-muscle band measurement.
  
  
  RESULTS
  Overall, 26% of patients on elective PCI had postprocedure biomarkers measured. These patients had more complex coronary anatomy and procedures but had similar rates of PCI success and inhospital mortality when compared with patients without biomarker measurement. The treating hospital was a significant factor associated with the likelihood of postprocedure biomarker surveillance. Hospitals that measured creatine kinase-muscle band in ≥ 90% of patients on elective PCI had lower associated 1-year mortality rates (adjusted hazard ratio 0.84, 95% CI 0.75-0.94) compared with hospitals that measured in < 10% of patients.
  
  
  CONCLUSIONS
  Among older patients undergoing elective PCI, postprocedure cardiac biomarker measurement occurred infrequently and was concentrated at certain hospitals. Hospitals that routinely measured post-PCI biomarkers were associated with lower long-term mortality compared with hospitals without routine measurement.
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: tracy.wang@duke.edu.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Lisa A
authors.initials: LA
authors.lastname: McCoy
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: Megan L
authors.initials: ML
authors.lastname: Neely
authors.forename: Kalon K L
authors.initials: KK
authors.lastname: Ho
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: H Vernon
authors.initials: HV
authors.lastname: Anderson
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality / Q000601:surgery; D000368:Aged; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D017558:Elective Surgical Procedures / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000401:mortality / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form