Abstract 9150: Re-Elevation of Troponin Following Percutaneous Coronary Intervention Significantly Predicts 1-Year Mortality in Patients with High-risk Non-ST-Segment Elevation Acute Coronary Syndromes
Background: The prognostic value of cardiac troponin (cTn) elevation post PCI is controversial. Moreover, in high-risk NSTE ACS patients presenting with elevated necrosis markers, the ability to use cTn to detect post-PCI MI is especially challenging: primarily this relates to discriminating PCI-related elevation from natural evolution of presenting MI. We addressed this issue by reviewing each cTn trend during the index ACS admission in all patients undergoing PCI randomized in the EARLY ACS (n=5552) and SYNERGY (n=4647) trials.
Methods: Time and cTn value (indexed by ULN) data pairs were plotted into graphics for each of 10,199 pts and independently reviewed by 2 physicians to detect post-PCI cTn (re)elevation (example in figure). Post-PCI cTn peak was identified for each plot, and the relationship between peak cTn post PCI and 1-year mortality was evaluated using Cox proportional hazard modeling, correcting for the 15 clinical variables of the EARLY ACS 1-year mortality model (including baseline cTn).
Results: Patients were classified into 3 groups: (i) (re)elevation post PCI not evaluable because cTn values rising through the time of PCI (group 1; N=4427 [43%]; excluded from further analyses); (ii) cTn values stable/falling with post-PCI (re)elevation detected (group 2; N=4276 [42%]); (iii) cTn values stable/falling but without post-PCI (re)elevation (group 3; n=1496 [15%]). In the multivariable model including patients in groups 2 and 3, peak cTn post PCI was significantly associated with a 7% increase in hazard of death per each 10xULN increase (adj. HR 1.07; 95% CI 1.03-1.11; p=0.0008).
Conclusion: We describe a methodology that allows clear differentiation of post-PCI cTn (re)elevation from presenting MI in over half of high-risk NSTE ACS patients undergoing PCI. This approach identified a highly significant relationship between post-PCI cTn and 1-year mortality and has relevance for the incorporation of cTn for definition of post-PCI MI.
- © 2011 by American Heart Association, Inc.