1
|
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.
Collapse
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
| |
Collapse
|