title: Defining the optimal cardiac troponin T threshold for predicting death caused by periprocedural myocardial infarction after percutaneous coronary intervention.
abstract: BACKGROUND
  There is controversy about the diagnostic and prognostic significance of percutaneous coronary intervention-related myocardial infarction, especially with the use of cardiac troponin T (cTnT). This analysis was designed to address the question of the presence and the level of a prognostic cTnT threshold.
  
  
  RESULTS
  We evaluated 5268 consecutive patients who underwent nonemergent percutaneous coronary intervention between 2000 and 2009 with a preprocedural cTnT level below the upper limit of normal (ULN, ≤0.01 ng/mL). Postprocedural cTnT and creatine kinase-MB mass levels (ULN, 6.7 ng/mL in men and 3.8 ng/mL in women) were found to be associated with 3-month mortality in Cox proportional hazard models (hazard ratio per doubling of cTnT, 1.24; 95% confidence interval, 1.08-1.43; P=0.003 and hazard ratio per doubling of creatine kinase-MB, 1.30; 95% confidence interval, 1.05-1.60; P=0.018), adjusted for the Mayo Clinic risk scores for in-hospital and postdischarge mortality. The optimal prognostic threshold for 3-month mortality was 25× ULN for cTnT (hazard ratio, 4.53; 99% confidence interval, 1.59-12.9; P<0.001), which provided similar information as a value of 5× ULN for creatine kinase-MB (hazard ratio, 4.31; 99% confidence interval, 1.27-14.6; P=0.002). The cumulative mortality rate was 0.6% at 91 days.
  
  
  CONCLUSIONS
  A significant association of postpercutaneous coronary intervention cardiac biomarker elevation with a small number of postpercutaneous coronary intervention outcomes was noted for the early (first 91 days) follow-up period with an identifiable optimal threshold of 25× ULN (0.25, ng/mL) for cTnT, which provided similar early outcome information as a cutoff of 5× ULN for creatine kinase-MB.
authors: From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George's, University of London, London, United Kingdom (A.P.).
authors: Joerg
authors: J
authors: Herrmann
authors: From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George's, University of London, London, United Kingdom (A.P.).
authors: Ryan J
authors: RJ
authors: Lennon
authors: From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George's, University of London, London, United Kingdom (A.P.).
authors: Allan S
authors: AS
authors: Jaffe
authors: From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George's, University of London, London, United Kingdom (A.P.).
authors: David R
authors: DR
authors: Holmes
authors: From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George's, University of London, London, United Kingdom (A.P.).
authors: Charanjit S
authors: CS
authors: Rihal
authors: From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George's, University of London, London, United Kingdom (A.P.). aprasad@sgul.ac.uk.
authors: Abhiram
authors: A
authors: Prasad
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000592:standards*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D020107:Troponin T / Q000378:metabolism
chemical_list: D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form
keywords: angioplasty; biomarkers; myocardial infarction; prognosis