European Heart Journal Advance Access originally published online on February 15, 2006
European Heart Journal 2006 27(9):1061-1069; doi:10.1093/eurheartj/ehi760
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Baseline troponin level: key to understanding the importance of post-PCI troponin elevations
1 Cardiovascular Division, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
2 Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
3 Division of Biostatistics, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
Received 25 July 2005; revised 15 December 2005; accepted 13 January 2006; online publish-ahead-of-print 15 February 2006.
* Corresponding author. Tel: +1 507 284 3685; fax: +1 507 266 9142. E-mail address: miller.wayne{at}mayo.edu
Aims The adverse prognostic significance of biomarker elevations after percutaneous coronary intervention (PCI) is well established. However, often baseline troponin values are not included in the analysis or sensitive criteria are not employed. Accordingly, we assessed the timing and magnitude of post-PCI troponin T (cTnT) levels and their relationships to outcomes in patients with and without pre-PCI baseline cTnT elevations using a sensitive assay and sensitive cut-off values.
Methods and results cTnT was measured at baseline (pre-PCI), 8 and 16 h post-PCI in 2352 patients. A cTnT elevation was defined as 
0.03 ng/mL. No baseline cTnT elevations were detected in 1619 patients undergoing mostly (97%) non-urgent procedures (cTnT=0.01±0.002 ng/mL; mean±SD). 733 patients had baseline cTnT elevations. Only the baseline troponin value had prognostic importance. Patients with elevated cTnT baseline levels had a higher overall cumulative 12-month death/MI rate of 11.1% compared with those without elevated baseline levels of 4.7% (P<0.05). Neither the timing nor the magnitude of the post-procedure cTnT elevations was predictive of long-term death/MI rates when baseline elevations were included in the analysis. Similar findings were observed for baseline creatine kinase-MB (CK-MB) levels. Late increases in cTnT levels (16 h post-PCI) presaged in-hospital events only.
Conclusion Long-term prognosis is most often related to the baseline pre-PCI troponin value and not the biomarker response to the PCI. These results support a re-evaluation of the use of biomarker data in relation to PCI.
Key Words: Troponin T • CK-MB mass • Baseline and peak biomarker values • PCI • Coronary artery disease
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