Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention

Hector M. Garcia-Garcia*, Eugène P. McFadden, Clemens von Birgelen, Tessa Rademaker-Havinga, Ernest Spitzer, Neal S. Kleiman, David J. Cohen, Kevin F. Kennedy, Edoardo Camenzind, Laura Mauri, Philippe Gabriel Steg, William Wijns, Sigmund Silber, Gerrit Anne van Es, Patrick W. Serruys, Stephan Windecker, Donald Cutlip, Pascal Vranckx

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)

Abstract

Objectives: This study sought to explore the association between biomarker elevation, with creatine kinase–myocardial band (CK-MB) or cardiac troponin (cTn), following percutaneous coronary intervention (PCI) and mortality in patients undergoing PCI for stable angina with normal baseline values.

Background: Several studies have shown a strong association between post-PCI CK-MB elevation and subsequent mortality. However, the prognostic significance of troponin elevation following coronary intervention is still debated.

Methods: Patient-level data from 5 contemporary coronary stent trials and 1 large registry were pooled. Mortality of patients with stable angina, with normal baseline biomarkers, was compared between patients with and those without different cutoff values of cTn and CK-MB.

Results: A total of 13,452 patients were included in this pooled analysis. The overall percentage of patients with elevated biomarkers following PCI was 23.9% for CK-MB and 68.4% for cTn. In the patient cohort for whom both assays were available (n = 8,859), 2.4% had both CK-MB ≥5 × the upper limit of normal (ULN) and cTn ≥35 × ULN, while 92% had both CK-MB <5 × ULN and cTn <35 × ULN. Among patients with CK-MB ≥5 × ULN (n = 315), 212 (67.3%) also had cTn ≥35 × ULN. Conversely, 390 of patients (64.8%) who had cTn ≥35 × ULN did not have CK-MB ≥5 × ULN. A total of 259 patients (1.9%) died at 1 year; 20 (7.7%) had CK-MB ≥5 × ULN, and 23 (8.8%) had cTn ≥35 × ULN. In the Cox multivariate analysis, in which the CK-MB and cTn ratios post-procedure were forced into the model, age, prior myocardial infarction, lesion complexity, hyperlipidemia, and CK-MB ratio (≥10) post-procedure were associated with increased 1-year mortality.

Conclusions: Following elective PCI in patients in stable condition treated with second-generation drug-eluting stent, CK-MB and cTn elevations remain common. After multivariate adjustment, there was an increased mortality rate with elevation of CK-MB after PCI, whereas cTn elevation was not independently associated with mortality at 1 year.

Original languageEnglish
Pages (from-to)1954-1962
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume12
Issue number19
DOIs
Publication statusPublished - 14 Oct 2019

Keywords

  • Cardiac troponin
  • CK-MB
  • Drug-eluting stent
  • Mortality
  • Percutaneous Coronary Intervention (PCI)

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    Garcia-Garcia, H. M., McFadden, E. P., von Birgelen, C., Rademaker-Havinga, T., Spitzer, E., Kleiman, N. S., ... Vranckx, P. (2019). Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention. JACC: Cardiovascular Interventions, 12(19), 1954-1962. https://doi.org/10.1016/j.jcin.2019.07.014