Post PCI High Sensitivity Troponin Elevation: No Prognostic Value

The prognostic value of high sensitivity troponin elevation after elective PCI in patients with or without elevated baseline values remains unclear.

The aim of this study was to measure the prognostic value of post elective procedure high sensitivity troponin and to determine whether this may be influenced by baselines TnT values.

The study included 5,626 patients undergoing coronary PCI with available baseline and post procedural TnT values. Primary end point 3 year mortality (estimating the risk by logarithmic increase of high sensitivity TnT value).

Patients were divided in four groups:

• nonelevated baseline and post procedure high sensitivity TnT (TnT ≤0.014 μg/l; n = 742),
• nonelevated baseline but elevated post procedure hs TnT values (pico post-procedimiento TnT >0.014 μg/l; n = 2,721),
• elevated baseline values (TnT >0.014 μg/l) but with no post procedure elevation (n = 516),
• elevated baseline values with even higher post procedure elevation (n = 1,647).

There were 265 deaths, 6 (2.3%) in patients with normal baseline and post procedural hs TnT, 54 (20.4%) in patients with normal baseline but elevated post procedural hs TnT, 50 (18.9%) in patients with elevated baseline hs TnT but no higher post procedural hs TnT, and 155 (58.5%) in patients with high sensitivity baseline and higher post procedural hs TnT (p<0.001).

After adjusting, elevated baseline values (HR 1.22; IC 95% 1.09 a 1.38; p < 0.001) were associated to mortality, but not the post procedure rise of hs TnT (HR 1.04; IC 95% 0.85 a 1.28; p=0.679).

Peak post procedural hs TnT was not associated with increased mortality in patients with normal baseline hs Tnt values (HR 0.93; IC 95% 0.69 a 1.25; p=0.653) or elevated baseline hs TnT values (HR 1.24; IC 95% 0.91 a 1.69; p=0.165).

Conclusion

In patients with heart disease undergoing programmed PCI, a rise in hs TnT values after procedure does not provide prognostic information beyond baseline TnT levels.

Editorial Comment

The definition of periprocedural MI used in clinical studies is more associated to events, as opposed to spontaneous MI.

Prior studies (Comparison of the Prognosis of Spontaneous and Percutaneous Coronary Intervention–Related Myocardial Infarction, Sergio Leonardi. JACC Vol. 60, No. 22, 2012) had already shown the benign evolution of periprocedural MI and the present study brings additional information in favor of this point.

Original Title: High-Sensitivity Troponin T and Mortality after Elective Percutaneous Coronary Intervention.

Reference: Gjin Ndrepepa et al. J Am Coll Cardiol. 2016;68(21):2259-2268.

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