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High troponin observed in one quarter of patients with stable CAD before PCI
In a new study, one quarter of patients with stable CAD undergoing elective PCI had elevated preprocedural levels of high-sensitivity cardiac troponin T, which was associated with increased risk for mortality at 1 year.
Researchers evaluated 2,029 of the 6,074 patients with stable CAD who were enrolled in the Bern PCI Registry between September 2010 and June 2014. High-sensitivity cardiac troponin T concentrations were measured at baseline (6 hours or less before PCI) and in at least one sample within 12 hours post-PCI. Follow-up occurred at hospital discharge and throughout 1 year to evaluate major adverse cardiac and cerebrovascular events.
Overall, 26% of patients had preprocedural high-sensitivity cardiac troponin T above the upper reference limit of 14 ng/L. Most patients (84%) with elevated baseline high-sensitivity cardiac troponin T had levels between one and three times with upper reference limit.
The primary endpoint of all-cause mortality at 1 year occurred in 7.7% of patients with elevated preprocedural high-sensitivity cardiac troponin T compared with 1.4% of patients with normal levels before PCI (P < .001). Patients with elevated preprocedural high-sensitivity cardiac troponin T had greater risk for all-cause mortality (HR = 6.69; 95% CI, 1.73-25.87) and cardiac mortality (HR = 5.73; 95% CI, 1.05-31.3) after PCI. Elevated preprocedural high-sensitivity cardiac troponin T was also associated with increased risk for BARC 3 to 5 bleeding (HR = 2; 95% CI, 1.04-3.86).
After multivariable adjustment for risk factors such as age, sex and renal failure, elevated preprocedural high-sensitivity cardiac troponin T persisted as an independent risk factor for 1-year all-cause mortality (adjusted HR = 2.08; 95% CI, 1.1-3.92). After adjustment, elevated levels did not independently predict cardiac mortality.
Cumulative event curves for mortality according to tertiles of high-sensitivity cardiac troponin T were suggestive of a graded risk for 1-year mortality across increasing levels of preprocedural high-sensitivity cardiac troponin T. Conversely, analysis centered on patients with normal levels of preprocedural high-sensitivity cardiac troponin T (n = 1,502) did not demonstrate a significant association of all-cause death with any levels of preprocedural high-sensivitiy cardiac troponin T ≤ 14 ng/L (P = .41).
“Routine measurement of high-sensitivity troponin T may be useful to refine risk stratification of stable, non–acute coronary syndrome patients undergoing elective coronary interventions,” researchers wrote in Circulation: Cardiovascular Interventions. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.