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(Circulation. 2008;118:632-638.)
© 2008 American Heart Association, Inc.

Interventional Cardiology

Prevalence and Prognostic Significance of Preprocedural Cardiac Troponin Elevation Among Patients With Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Results From the Evaluation of Drug Eluting Stents and Ischemic Events Registry

Allen Jeremias, MD, MSc; Neal S. Kleiman, MD; Deborah Nassif, PhD; Wen-Hua Hsieh, PhD; Michael Pencina, PhD; Kelly Maresh, RN; Manish Parikh, MD; Donald E. Cutlip, MD; Ron Waksman, MD; Steven Goldberg, MD; Peter B. Berger, MD; David J. Cohen, MD, MSc, for the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) Registry Investigators

From Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, NY (A.J.); Harvard Clinical Research Institute, Boston, Mass (D.N., W.H., M.P., D.E.C.); Lenox Hill Hospital, New York, NY (M.P.); Washington Hospital Center, Washington, DC (R.W.); University of Washington Medical Center, Seattle (S.G.); Geisinger Clinic, Danville, Pa (P.B.B.); Methodist DeBakey Heart Center, Houston, Tex (K.M., N.S.K.); and Saint-Luke’s Mid America Heart Institute, Kansas City, Mo (D.J.C.).

Correspondence to David J. Cohen, MD, MSc, Saint-Luke’s Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO 64111. E-mail dcohen{at}saint-lukes.org

Received November 13, 2007; accepted May 14, 2008.

Background— Although cardiac troponin (cTn) elevation is associated with periprocedural complications during percutaneous coronary intervention (PCI) in the setting of acute coronary syndromes, the prevalence and prognostic significance of preprocedural cTn elevation among patients with stable coronary artery disease undergoing PCI are unknown.

Methods and Results— Between July 2004 and September 2006, 7592 consecutive patients who underwent attempted stent placement at 47 hospitals throughout the United States were enrolled in a prospective multicenter registry. We analyzed the frequency of an elevated cTn immediately before PCI and its relationship to in-hospital and 1-year outcomes among patients who underwent PCI for either stable angina or a positive stress test. Among the stable coronary artery disease population (n=2382, 31.4%), 142 (6.0%) had a cTn level above the upper limit of normal before the procedure. Compared with patients who had normal baseline cTn, patients with elevated cTn had a higher rate of in-hospital death or myocardial infarction (13.4% versus 5.6%; P<0.001) and a trend toward higher rates of urgent repeat PCI (1.4% versus 0.2%; P=0.06). In multivariable analyses adjusted for demographic, clinical, angiographic, and procedural factors, baseline cTn elevation remained independently associated with the composite of death or myocardial infarction at hospital discharge (odds ratio, 2.1; 95% confidence interval, 1.2 to 3.8; P=0.01) and at the 1-year follow-up (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.3; P=0.005).

Conclusions— Baseline elevation of cTn is relatively common among patients with stable coronary artery disease undergoing PCI and is an independent prognostic indicator of ischemic complications. If these data are confirmed in future studies, consideration should be given to routine testing of cTn before performance of PCI in this patient population.

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