CLINICAL STUDY
Prognostic significance of elevated troponin i after percutaneous coronary intervention
Warren J. Cantor, MD*,*,
L. Kristin Newby, MD, FACC ,
Robert H. Christenson, PhD ,
Robert H. Tuttle, MSPH,
Vic Hasselblad, PhD,
Paul W. Armstrong, MD, FACC ,
David J. Moliterno, MD, FACC||,
Robert M. Califf, MD, FACC,
Eric J. Topol, MD, FACC||,
E. Magnus Ohman, MD, FACC the SYMPHONY and 2nd SYMPHONY Cardiac Markers Substudy Investigators
* St. Michael’s Hospital, Division of Cardiology, Toronto, Ontario, Canada
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
Department of Pathology, University of Maryland Medical System, Baltimore, Maryland, USA
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
|| Cleveland Clinic Foundation, Cleveland, Ohio, USA
Manuscript received October 31, 2001;
revised manuscript received February 27, 2002,
accepted March 13, 2002.
* Reprint request and correspondence: Dr. Warren J. Cantor, St. Michael’s Hospital, Division of Cardiology, 30 Bond St., Toronto, Ontario, Canada M5B-1W8.
cantorw{at}smh.toronto.on.ca
OBJECTIVES: We sought to assess the incidence and clinical significance of elevated cardiac troponin I (cTnI) after percutaneous coronary intervention (PCI).
BACKGROUND: Elevated creatine kinase-MB (CK-MB) is prognostically important after PCI, but the prognostic significance of elevated cTnI after PCI is uncertain.
METHODS: In a prospective substudy of the Sibrafiban Versus Aspirin to Yield Maximum Protection From Ischemic Heart Events Post-acute Coronary Syndromes (SYMPHONY) trials, which randomized patients with acute coronary syndromes (ACS) to receive aspirin or sibrafiban, we measured cTnI (positive,  1.5 ng/ml) and CK-MB (positive, 7 ng/ml) in 481 patients with PCI. Samples were collected immediately before and at 0, 8 and 16 h after PCI and analyzed by a core laboratory. The primary end point was the Kaplan-Meier estimate of death, myocardial infarction or severe, recurrent ischemia at 90 days.
RESULTS: Overall, 230 patients (48%) had elevated cTnI after PCI. Such patients underwent PCI sooner and were more likely to have coronary stenting. Elevated cTnI was associated with nonsignificantly higher risks of the primary end point (11.5% vs. 8.7%; p = 0.15) and of death (1.8% vs. 0.4%; p = 0.4) and a significantly higher risk of death or infarction (10.6% vs. 4.2%; p = 0.005). This pattern was more pronounced for patients who became positive only after PCI: primary end point, 20.7% vs. 10.1% for patients who remained negative after PCI (p = 0.05); death, 5.2% vs. 0% (p = 0.02); death or infarction, 18.1% vs. 4.1% (p = 0.007).
CONCLUSIONS: Elevated cTnI, often observed after PCI in patients with ACS, is associated with worse 90-day clinical outcomes. This marker, therefore, is a useful prognostic indicator in such patients.
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Abbreviations and Acronyms
| | ACS | | acute coronary syndromes | | CI | | confidence interval | | CK-MB | | creatine kinase-MB | | cTnI | | cardiac troponin I | | HR | | hazard ratio | | KM | | Kaplan-Meier | | MI | | myocardial infarction | | PCI | | percutaneous coronary intervention | | SRI | | severe recurrent ischemia | | SYMPHONY | | Sibrafiban Versus Aspirin to Yield Maximum Protection From Ischemic Heart Events Post-acute Coronary Syndromes trial |
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