Key result
Post-PCI single or multimarker biomarker elevation failed to predict major cardiac events at 9 months (1% death, 10.3% non-fatal MI overall) in patients with normal baseline biomarkers.
Why the study?
Does a multimarker risk stratification approach (measuring CK-MB, cTnT, hs-CRP, and NT-proBNP) predict cardiovascular outcomes in patients with stable coronary artery disease and normal baseline biomarkers undergoing elective PCI?
Cohort (n=302)
No
Does a multimarker risk stratification approach (measuring CK-MB, cTnT, hs-CRP, and NT-proBNP) predict cardiovascular outcomes in patients with stable coronary artery disease and normal baseline biomarkers undergoing elective PCI?
Simultaneous post-PCI assessment of cardiac troponin T, CK-MB, hs-CRP, and NT-proBNP does not provide incremental prognostic value for predicting medium-term major adverse cardiac events in patients with stable coronary artery disease and normal baseline biomarkers.
May not improve post-PCI risk stratification in stable CAD with normal baselines; leaves open utility in higher-risk or acute settings.
AIMS: We studied the utility of multimarker risk stratification approach to predict cardiovascular outcomes in patients with stable coronary artery disease, undergoing elective percutaneous coronary intervention (PCI). METHODS: We prospectively evaluated 302 consecutive patients with stable coronary artery disease and normal CPK-MB and cardiac troponin T levels, and who underwent elective PCI at our institution. The following cardiac biomarkers were measured before and between 12 and 24h post-procedure: CK-MB, cardiac troponin T, hs-CRP, and NT-ProBNP. Patients were followed up for a minimum of 6 months. RESULTS: Post-PCI, CPK-MB levels were elevated but below myocardial infarction (MI) range in 70 patients (23%), and in the MI range in 6 patients (2%). Troponin T levels were detectable but below the 99th percentile (microleak) in 32 patients (10.6%) and elevated above the 99th percentile (periprocedural MI) in 104 patients (34.4%). At 9 months' follow-up, 1% died, 2% had stable angina, 10.3% had non-fatal MI, and 87.7% remained asymptomatic. There was no significant difference in clinical events among groups stratified by elevation of one biomarker or multiple biomarkers. CONCLUSION: Single or multiple biomarker strategy in patients with normal baseline biomarkers failed to predict major cardiac events after PCI over medium-term follow-up.
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Mehta et al. (2016) conducted a cohort in Stable coronary artery disease undergoing elective percutaneous coronary intervention (PCI) (n=302). Post-PCI elevation of cardiac biomarkers (CK-MB, cardiac troponin T, hs-CRP, NT-proBNP) vs. Normal post-PCI cardiac biomarker levels was evaluated on Major adverse cardiovascular events (composite of death from any cause, myocardial infarction, and need for repeat revascularization). Post-PCI single or multimarker biomarker elevation failed to predict major cardiac events at 9 months (1% death, 10.3% non-fatal MI overall) in patients with normal baseline biomarkers.
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