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

1 Citation (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

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Creatine
Troponin
Percutaneous Coronary Intervention
Biomarkers
Mortality
Stable Angina
Drug-Eluting Stents
Hyperlipidemias
Stents
Registries
Reference Values
Multivariate Analysis

Keywords

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

Cite this

Garcia-Garcia, Hector M. ; McFadden, Eugène P. ; von Birgelen, Clemens ; Rademaker-Havinga, Tessa ; Spitzer, Ernest ; Kleiman, Neal S. ; Cohen, David J. ; Kennedy, Kevin F. ; Camenzind, Edoardo ; Mauri, Laura ; Steg, Philippe Gabriel ; Wijns, William ; Silber, Sigmund ; van Es, Gerrit Anne ; Serruys, Patrick W. ; Windecker, Stephan ; Cutlip, Donald ; Vranckx, Pascal. / Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention. In: JACC: Cardiovascular Interventions. 2019 ; Vol. 12, No. 19. pp. 1954-1962.
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title = "Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention",
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.",
keywords = "Cardiac troponin, CK-MB, Drug-eluting stent, Mortality, Percutaneous Coronary Intervention (PCI)",
author = "Garcia-Garcia, {Hector M.} and McFadden, {Eug{\`e}ne P.} and {von Birgelen}, Clemens and Tessa Rademaker-Havinga and Ernest Spitzer and Kleiman, {Neal S.} and Cohen, {David J.} and Kennedy, {Kevin F.} and Edoardo Camenzind and Laura Mauri and Steg, {Philippe Gabriel} and William Wijns and Sigmund Silber and {van Es}, {Gerrit Anne} and Serruys, {Patrick W.} and Stephan Windecker and Donald Cutlip and Pascal Vranckx",
year = "2019",
month = "10",
day = "14",
doi = "10.1016/j.jcin.2019.07.014",
language = "English",
volume = "12",
pages = "1954--1962",
journal = "JACC : cardiovascular interventions",
issn = "1936-8798",
publisher = "Elsevier",
number = "19",

}

Garcia-Garcia, HM, McFadden, EP, von Birgelen, C, Rademaker-Havinga, T, Spitzer, E, Kleiman, NS, Cohen, DJ, Kennedy, KF, Camenzind, E, Mauri, L, Steg, PG, Wijns, W, Silber, S, van Es, GA, Serruys, PW, Windecker, S, Cutlip, D & Vranckx, P 2019, 'Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention', JACC: Cardiovascular Interventions, vol. 12, no. 19, pp. 1954-1962. https://doi.org/10.1016/j.jcin.2019.07.014

Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention. / Garcia-Garcia, Hector M.; McFadden, Eugène P.; von Birgelen, Clemens; Rademaker-Havinga, Tessa; Spitzer, Ernest; Kleiman, Neal S.; Cohen, David J.; Kennedy, Kevin F.; Camenzind, Edoardo; Mauri, Laura; Steg, Philippe Gabriel; Wijns, William; Silber, Sigmund; van Es, Gerrit Anne; Serruys, Patrick W.; Windecker, Stephan; Cutlip, Donald; Vranckx, Pascal.

In: JACC: Cardiovascular Interventions, Vol. 12, No. 19, 14.10.2019, p. 1954-1962.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention

AU - Garcia-Garcia, Hector M.

AU - McFadden, Eugène P.

AU - von Birgelen, Clemens

AU - Rademaker-Havinga, Tessa

AU - Spitzer, Ernest

AU - Kleiman, Neal S.

AU - Cohen, David J.

AU - Kennedy, Kevin F.

AU - Camenzind, Edoardo

AU - Mauri, Laura

AU - Steg, Philippe Gabriel

AU - Wijns, William

AU - Silber, Sigmund

AU - van Es, Gerrit Anne

AU - Serruys, Patrick W.

AU - Windecker, Stephan

AU - Cutlip, Donald

AU - Vranckx, Pascal

PY - 2019/10/14

Y1 - 2019/10/14

N2 - 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.

AB - 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.

KW - Cardiac troponin

KW - CK-MB

KW - Drug-eluting stent

KW - Mortality

KW - Percutaneous Coronary Intervention (PCI)

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U2 - 10.1016/j.jcin.2019.07.014

DO - 10.1016/j.jcin.2019.07.014

M3 - Article

C2 - 31601389

AN - SCOPUS:85072582310

VL - 12

SP - 1954

EP - 1962

JO - JACC : cardiovascular interventions

JF - JACC : cardiovascular interventions

SN - 1936-8798

IS - 19

ER -