Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Role of cardiac troponin T in the long-term risk stratification of patients undergoing percutaneous coronary intervention
a Division of Cardiology, Department of Medicine and Public Health, Weill Medical College of Cornell University, New York, NY, USA
b Cardiovascular Division, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
c Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
d Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pitsburgh, PA, USA
* Correspondence to: Robert L. Wilensky, MD, Cardiovascular Division, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9 Gates, Philadelphia, PA 19104. Tel: (215) 615-3060; fax: (215) 615-3073
E-mail address: robert.wilensky{at}uphs.upenn.edu
Received 26 November 2002; revised 5 March 2003; accepted 18 April 2003
Aims To investigate the long-term prognostic significance of pre- and post-procedure troponin T (TnT) elevations in patients undergoing percutaneous coronary intervention (PCI).
Methods and results TnT and CK-MB were measured pre- and post-procedure in 212 patients undergoing PCI. Major adverse events (composite of death, myocardial infarction and revascularization) were ascertained 6 years later. Pre-procedural TnT was a significant independent predictor of time to major events (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.16–2.64) and death or myocardial infarction. Post-procedural TnT elevation above normal was the only independent predictor of the primary end-point at 1 year (HR 2.39, 95% CI 1.09–5.26) but was not significantly related to event-free survival throughout follow-up. Post-PCI elevation of TnT 5x above normal, however, did significantly predict time to events during the entirety of follow-up. By contrast, CK-MB was not an independent predictor in any of the analyses.
Conclusions Our study confirms the long-term prognostic value of pre-procedural TnT elevation in patients undergoing PCI, and demonstrates the superior predictive ability of a post-procedural increase in TnT 5x normal for long-term adverse events. Whether the prognostic significance of smaller post-procedural TnT elevations extends beyond the intermediate-term awaits further investigation.
Key Words: Angioplasty • Creatine kinase • Myocardial infarction
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