title: Troponin I elevation and all-cause mortality after elective percutaneous coronary interventions.
abstract: OBJECTIVE
  Although troponin I (TnI) elevation and myocardial injury after percutaneous coronary interventions (PCI) are frequent findings, their prognoses remain controversial. We aimed to determine the association between any or ≥5 times TnI elevation after elective PCI and subsequent one year mortality rates and long term survival.
  
  
  METHODS
  Consecutive patients admitted for elective PCI between January 2013 and December 2014 were retrospectively analyzed by chart review in two hospitals in Rio de Janeiro. Only patients with post-PCI TnI measurements were included. Clinical, angiographic and procedural characteristics were correlated with any or ≥5 times TnI elevation, as well as 1year mortality and long term survival.
  
  
  RESULTS
  A total of 407 interventions were included in the analysis. Post-PCI TnI elevation was observed in 74.7% of cases and ≥5 times elevations occurred in 41.3%. Age≥70years, female gender and multistenting were predictors of enzyme elevation. Prior aspirin or hypoglycemic therapy were protective factors. One year mortality was significantly associated with any TnI elevation (6.6% vs 1.05%, p=0.035) and values ≥5 times above the normal limit predicted the highest mortality rates (8.13% vs 3.14%, p=0.031). Survival of patients with single vessel disease was also adversely affected by ≥5 times enzyme elevation (log-rank: p=0.039).
  
  
  CONCLUSIONS
  Troponin I elevation after elective PCI is frequent and associated with progressively higher mortality rates at 1year. A cutoff value ≥5 times the 99th percentile, currently defined as myocardial injury, appears to be an even more significant predictor of this outcome, even in lower risk subgroups.
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913; Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ, Brazil, 22251-050. Electronic address: betomf@terra.com.br.
authors.forename: Roberto Muniz
authors.initials: RM
authors.lastname: Ferreira
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Nelson Albuquerque
authors.initials: NA
authors.lastname: de Souza E Silva
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Lúcia Helena Alvares
authors.initials: LHA
authors.lastname: Salis
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Rafael Ramos Mendes
authors.initials: RRM
authors.lastname: da Silva
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Paula Dias
authors.initials: PD
authors.lastname: Maia
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Lucas Felipe Bastos
authors.initials: LFB
authors.lastname: Horta
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Eliene Ferreira
authors.initials: EF
authors.lastname: Salles
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Henrique Moraes Pinto
authors.initials: HMP
authors.lastname: Nunes
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Joana Beatriz Moutinho
authors.initials: JBM
authors.lastname: de Oliveira
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Yasminne Pascoal de Sousa
authors.initials: YPS
authors.lastname: Domingues
authors.affiliation: Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913.
authors.forename: Clarissa Castrighini Macedo
authors.initials: CCM
authors.lastname: de Sousa
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001938:Brazil; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality*; D065840:Protective Factors; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D019210:Troponin I
keywords: Coronary disease; Heart catheterization; Troponin