Key result
In patients undergoing elective PCI, peak post-procedural hs-TnT levels were not associated with an increased risk of 3-year mortality (HR 1.04; 95% CI 0.85-1.28; p=0.679) after adjustment.
Why the study?
The prognostic value of post-procedural hs-TnT elevation after elective PCI in patients with or without raised baseline hs-TnT levels was unclear.
Does post-procedural hs-TnT elevation increase 3-year mortality in patients undergoing elective PCI?
Cohort (n=5,626)
Does post-procedural hs-TnT elevation increase 3-year mortality in patients undergoing elective PCI?
In patients undergoing elective PCI, post-procedural hs-TnT elevation does not provide additional prognostic information for 3-year mortality beyond baseline hs-TnT levels.
Answers are grounded in this paper and cite their sources.
Post-procedural hs-TnT adds no prognostic value beyond baseline after elective PCI; leaves open whether serial measurement improves risk stratification.
BACKGROUND: The prognostic value of high-sensitivity troponin T (hs-TnT) elevation after elective percutaneous coronary intervention (PCI) in patients with or without raised baseline hs-TnT levels is unclear. OBJECTIVES: The goal of this study was to assess whether the prognostic value of post-procedural hs-TnT level after elective PCI depends on the baseline hs-TnT level. METHODS: This study included 5,626 patients undergoing elective PCI who had baseline and peak post-procedural hs-TnT measurements available. The primary outcome was 3-year mortality (with risk estimates calculated per SD increase of the log hs-TnT scale). RESULTS: Patients were divided into 4 groups: nonelevated baseline and post-procedural hs-TnT levels (hs-TnT ≤0.014 μg/l; n = 742); nonelevated baseline but elevated post-procedural hs-TnT levels (peak post-procedural hs-TnT >0.014 μg/l; n = 2,721); elevated baseline hs-TnT levels (hs-TnT >0.014 μg/l) with no further rise post-procedure (n = 516); and elevated baseline hs-TnT levels with a further rise post-procedure (n = 1,647). A total of 265 deaths occurred: 6 (1.6%) in patients with nonelevated baseline and post-procedural hs-TnT levels; 54 (3.8%) in patients with nonelevated baseline but elevated post-procedural hs-TnT levels; 50 (16.0%) in patients with elevated baseline hs-TnT levels with no further rise post-procedure; and 155 (18.2%) in patients with elevated baseline hs-TnT levels with a further rise post-procedure (p < 0.001). After adjustment, baseline hs-TnT levels (hazard ratio [HR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.38; p < 0.001) but not peak post-procedural hs-TnT levels (HR: 1.04; 95% CI: 0.85 to 1.28; p = 0.679) were associated with an increased risk of mortality. Peak post-procedural hs-TnT findings were not associated with mortality in patients with nonelevated (HR: 0.93; 95% CI: 0.69 to 1.25; p = 0.653) or elevated (HR: 1.24; 95% CI: 0.91 to 1.69; p = 0.165) baseline hs-TnT levels. CONCLUSIONS: In patients with coronary artery disease undergoing elective PCI, an increase in post-procedural hs-TnT level did not offer prognostic information beyond that provided by the baseline level of the biomarker.
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Ndrepepa et al. (2016) conducted a cohort in Coronary artery disease undergoing elective PCI (n=5,626). Peak post-procedural hs-TnT levels vs. Baseline hs-TnT levels was evaluated on 3-year mortality (HR 1.04, 95% CI 0.85 to 1.28, p=0.679). In patients undergoing elective PCI, peak post-procedural hs-TnT levels were not associated with an increased risk of 3-year mortality (HR 1.04; 95% CI 0.85-1.28; p=0.679) after adjustment.
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