Key result
Elevated peak post-procedural troponin T was not significantly associated with increased long-term all-cause mortality compared to normal levels in patients with stable angina pectoris undergoing elective PCI.
Why the study?
Does elevated post-PCI cardiac biomarkers (cTnT and CK-MBmass) impact prognosis in patients with stable angina pectoris undergoing elective PCI?
Cohort (n=2,760)
No
Does elevated post-PCI cardiac biomarkers (cTnT and CK-MBmass) impact prognosis in patients with stable angina pectoris undergoing elective PCI?
Elevated peri-procedural cardiac biomarkers (cTnT and CK-MBmass) after elective PCI in stable angina patients do not significantly impact long-term all-cause mortality.
Answers are grounded in this paper and cite their sources.
May not alter post-PCI surveillance in stable angina; leaves open need for prospective validation of troponin utility.
BACKGROUND: The clinical significance of myocardial infarction related to treatment with percutaneous coronary intervention (PCI) has been subject of great discussion. This subject has been studied for many years using different definitions of peri-procedural myocardial infarction and different biomarkers, the results have varied greatly depending on methods and time of the study. This study was to determine the incidence and prognostic significance of elevated cardiac biomarkers after elective PCI in patients with stable angina pectoris using the current cut-off set by the Third Universal Definition of Myocardial Infarction and current biomarkers. METHODS: We performed a historical prospective follow-up study of all patients with stable angina pectoris who underwent elective PCI at Aalborg University Hospital, Denmark from January 1(st) 2000 to December 31(st) 2012. We stratified patients according to peak post-PCI troponin T (cTnT) and Creatine Kinase MB mass (CK-MBmass). RESULTS: Follow-up for time to all-cause mortality was mean 5.8 years and total 15,891 years and mean 3.7 years and total 10,160 years for the combined endpoint of all-cause mortality and new onset heart failure. During the follow up period 399 of 2760 patients died (14.5 %) and 1095 (39.7 %) suffered the combined endpoint. Post-PCI concentration of cTnT and CK-MBmass was elevated above the defined cut-off in 419 patients (15.2 %) and 113 patients (4.1 %) respectively. There was no statistically significant difference between the groups in stratified analysis of the hazard rates by time regarding all-cause mortality for cTnT nor CK-MBmass. Regarding the combined endpoint the results were ambiguous. The results were unchanged in multivariable analyses that included age and gender. CONCLUSION: The incidence of elevated biomarkers after elective PCI in patients with stable angina pectoris using the defined cut-off (>5 x URL) was 15.2 % using cTnT and 4.1 % using CK-MBmass. The independent prognostic value for both cardiac biomarkers of any cut-off showed no statistical significance for all-cause mortality, whereas the combined endpoint (all-cause mortality or new-onset heart failure) were ambiguous in both short- and long-term follow-up.
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Christensen et al. (2016) conducted a cohort in Stable angina pectoris (n=2,760). Elevated peak post-PCI troponin T (>200 ng/L) vs. Normal peak post-PCI troponin T (≤14 ng/L) was evaluated on All-cause mortality (HR 1.21, 95% CI 0.92-1.60, p=0.17). Elevated peak post-procedural troponin T was not significantly associated with increased long-term all-cause mortality compared to normal levels in patients with stable angina pectoris undergoing elective PCI.
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