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Ferreira RM, de Souza E Silva NA, Salis LHA, da Silva RRM, Maia PD, Horta LFB, Salles EF, Nunes HMP, de Oliveira JBM, Domingues YPDS, de Sousa CCM. Troponin I elevation and all-cause mortality after elective percutaneous coronary interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:255-260. [PMID: 28131744 DOI: 10.1016/j.carrev.2017.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/30/2016] [Accepted: 01/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND/PURPOSE Although troponin I (TnI) elevation and myocardial injury after percutaneous coronary interventions (PCI) are frequent findings, their prognoses remain controversial. We aimed to determine the association between any or ≥5 times TnI elevation after elective PCI and subsequent one year mortality rates and long term survival. METHODS Consecutive patients admitted for elective PCI between January 2013 and December 2014 were retrospectively analyzed by chart review in two hospitals in Rio de Janeiro. Only patients with post-PCI TnI measurements were included. Clinical, angiographic and procedural characteristics were correlated with any or ≥5 times TnI elevation, as well as 1year mortality and long term survival. RESULTS A total of 407 interventions were included in the analysis. Post-PCI TnI elevation was observed in 74.7% of cases and ≥5 times elevations occurred in 41.3%. Age≥70years, female gender and multistenting were predictors of enzyme elevation. Prior aspirin or hypoglycemic therapy were protective factors. One year mortality was significantly associated with any TnI elevation (6.6% vs 1.05%, p=0.035) and values ≥5 times above the normal limit predicted the highest mortality rates (8.13% vs 3.14%, p=0.031). Survival of patients with single vessel disease was also adversely affected by ≥5 times enzyme elevation (log-rank: p=0.039). CONCLUSION Troponin I elevation after elective PCI is frequent and associated with progressively higher mortality rates at 1year. A cutoff value ≥5 times the 99th percentile, currently defined as myocardial injury, appears to be an even more significant predictor of this outcome, even in lower risk subgroups.
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Affiliation(s)
- Roberto Muniz Ferreira
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913; Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ, Brazil, 22251-050.
| | - Nelson Albuquerque de Souza E Silva
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Lúcia Helena Alvares Salis
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Rafael Ramos Mendes da Silva
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Paula Dias Maia
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Lucas Felipe Bastos Horta
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Eliene Ferreira Salles
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Henrique Moraes Pinto Nunes
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Joana Beatriz Moutinho de Oliveira
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Yasminne Pascoal de Sousa Domingues
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
| | - Clarissa Castrighini Macedo de Sousa
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil, 21941-913
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Tandjung K, Basalus MW, Muurman E, Louwerenburg HW, van Houwelingen KG, Stoel MG, de Man FH, Jansen H, Huisman J, Linssen GC, Droste HT, Nienhuis MB, von Birgelen C. Incidence of periprocedural myocardial infarction following stent implantation: Comparison between first- and second-generation drug-eluting stents. Catheter Cardiovasc Interv 2011; 80:524-30. [DOI: 10.1002/ccd.23334] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 08/07/2011] [Indexed: 11/12/2022]
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Bauer T, Möllmann H, Zeymer U, Hochadel M, Nef H, Weidinger F, Zahn R, Hamm CW, Marco J, Gitt AK. Multivessel percutaneous coronary intervention in patients with stable angina: a common approach? Lessons learned from the EHS PCI registry. Heart Vessels 2011; 27:453-9. [DOI: 10.1007/s00380-011-0207-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 07/08/2011] [Indexed: 11/30/2022]
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Nienhuis M, Ottervanger J, Dambrink JH, Dikkeschei L, Suryapranata H, van ‘t Hof A, Hoorntje J, de Boer M, Gosselink A, Zijlstra F. Troponin T elevation and prognosis after multivessel compared with single-vessel elective percutaneous coronary intervention. Neth Heart J 2007; 15:178-83. [PMID: 17612680 PMCID: PMC1877967 DOI: 10.1007/bf03085977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND.: Although techniques for percutaneous coronary intervention (PCI) have improved, patients with PCI of more vessels may still have an increased risk. We performed a prospective observational study evaluating the differences between multivessel and single-vessel procedures according to postprocedural troponin T (TnT) elevation and events during follow-up. METHODS.: The study included 713 patients without elevated TnT (<0.05 ng/ml) before PCI. Primary endpoint was the combined endpoint of death, myocardial infarction, stroke, repeat coronary angiography and readmission for anginal symptoms during the mean follow-up of 10.9 months. RESULTS.: TnT after PCI was elevated in 150 patients (21%) and was significantly associated with an increased incidence of the primary endpoint (RR 1.55, 95% CI 1.01 to 2.38). PCI of more than one vessel was performed in 146 patients (20%). These patients more often had increased TnT levels after the procedure (31.5 vs. 18.3%, p=0.001) and an increased incidence of the primary endpoint during follow-up (28 vs. 19%, p=0.01). After multivariable analysis, multivessel PCI was a statistically significant predictor of postprocedural TnT increase (OR 1.90, 95% CI 1.17 to 3.06). Multivessel PCI was also associated with an increased risk of the primary endpoint (OR 1.73, 95% CI 1.18 to 2.52), but after adjusting for multivessel disease this association was not statistically significant (OR 1.42, 95% CI 0.92 to 2.19). CONCLUSION.: Elective PCI of more vessels in one session is, in comparison with single-vessel PCI, more often associated with postprocedural troponin T rise and a (nonsignificantly) higher incidence of cardiac events during follow-up. Whether staged PCI is associated with less morbidity has to be assessed. (Neth Heart J 2007;15:178-83.).
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Affiliation(s)
- M.B. Nienhuis
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - J.P. Ottervanger
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - J-H.E. Dambrink
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - L.D. Dikkeschei
- Department of Clinical Chemistry, Isala Clinics, Zwolle, the Netherlands
| | - H. Suryapranata
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | | | - J.C.A. Hoorntje
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - M.J. de Boer
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - A.T.M. Gosselink
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - F. Zijlstra
- Department of Cardiology, University Medical Centre Groningen, Groningen, the Netherlands
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