Preprocedural High-Sensitivity Cardiac Troponin T and Clinical Outcomes in Patients With Stable Coronary Artery Disease Undergoing Elective Percutaneous Coronary Intervention.
Cardiac troponin detected by new-generation, highly sensitive assays predicts clinical outcomes among patients with stable coronary artery disease (SCAD) treated medically. The prognostic value of baseline high-sensitivity cardiac troponin T (hs-cTnT) elevation in SCAD patients undergoing elective percutaneous coronary interventions is not well established. This study assessed the association of preprocedural levels of hs-cTnT with 1-year clinical outcomes among SCAD patients undergoing percutaneous coronary intervention.



Between 2010 and 2014, 6974 consecutive patients were prospectively enrolled in the Bern Percutaneous Coronary Interventions Registry. Among patients with SCAD (n=2029), 527 (26%) had elevated preprocedural hs-cTnT above the upper reference limit of 14 ng/L. The primary end point, mortality within 1 year, occurred in 20 patients (1.4%) with normal hs-cTnT versus 39 patients (7.7%) with elevated baseline hs-cTnT (P<0.001). Patients with elevated hs-cTnT had increased risks of all-cause (hazard ratio 5.73; 95% confidence intervals 3.34-9.83; P<0.001) and cardiac mortality (hazard ratio 4.68; 95% confidence interval 2.12-10.31; P<0.001). Preprocedural hs-TnT elevation remained an independent predictor of 1-year mortality after adjustment for relevant risk factors, including age, sex, and renal failure (adjusted hazard ratio 2.08; 95% confidence interval 1.10-3.92; P=0.024). A graded mortality risk was observed across higher tertiles of elevated preprocedural hs-cTnT, but not among patients with hs-cTnT below the upper reference limit.



Preprocedural elevation of hs-cTnT is observed in one fourth of SCAD patients undergoing elective percutaneous coronary intervention. Increased levels of preprocedural hs-cTnT are proportionally related to the risk of death and emerged as independent predictors of all-cause mortality within 1 year.



URL: http://www.clinicaltrials.gov. Unique identifier: NCT02241291.
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Thomas
T
Zanchin
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Lorenz
L
Räber
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Konstantinos C
KC
Koskinas
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Raffaele
R
Piccolo
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Peter
P
Jüni
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Thomas
T
Pilgrim
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Stefan
S
Stortecky
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Ahmed A
AA
Khattab
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Peter
P
Wenaweser
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Stefan
S
Bloechlinger
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Aris
A
Moschovitis
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Andre
A
Frenk
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Christina
C
Moro
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Bernhard
B
Meier
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Georg M
GM
Fiedler
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.).
Dik
D
Heg
From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.). stephan.windecker@insel.ch.
Stephan
S
Windecker
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation
D015415:Biomarkers; C545568:TNNT2 protein, human; D020107:Troponin T
all-cause death; coronary intervention; percutaneous coronary intervention; prognosis; stable coronary artery disease; troponin T