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CLINICAL RESEARCH: STUDIES WITH TROPONIN

Isolated Elevation in Troponin T After Percutaneous Coronary Intervention Is Associated With Higher Long-Term Mortality

Abhiram Prasad, MD, FRCP, FACC^_*,_*, Mandeep Singh, MD, FACC^_*, Amir Lerman, MD, FACC^_*, Ryan J. Lennon, MS, David R. Holmes, Jr, MD, FACC^_* and Charanjit S. Rihal, MD, FACC^_*

^_* Division of Cardiovascular Diseases, Department of Internal Medicine, Rochester, Minnesota
Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.

Manuscript received January 13, 2006; revised manuscript received April 20, 2006, accepted April 23, 2006.

^_* Reprint requests and correspondence: Dr. Abhiram Prasad, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. (Email: prasad.abhiram{at}mayo.edu).

OBJECTIVES: The aim of this study was to evaluate whether, in patients with normal post-procedure CK-MB, an isolated elevation in cardiac troponin T (cTnT) predicts long-term survival.

BACKGROUND: Cardiac troponin T is a sensitive and specific marker of myonecrosis. There is little known about the incidence and prognostic significance of an isolated elevation of cTnT without a rise in creatine kinase (CK)-MB following PCI.

METHODS: We evaluated the outcomes of 1,949 patients from the Mayo Clinic registry who had normal pre-procedure cTnT and CK-MB, required nonemergency percutaneous coronary intervention (PCI), and had normal CK-MB after the procedure.

RESULTS: An elevation in cTnT (cTnT+) was observed in 383 patients (19.6%) (median 0.04 ng/ml, interquartile range 0.03 to 0.06 ng/ml). The TnT+ status was associated with adverse clinical and angiographic characteristics, and multivessel PCI. Over the median follow-up duration of 26 months, mortality (p < 0.001) and the combined rate of death and myocardial infarction (p = 0.004) were significantly higher in cTnT+ patients. Estimated 3-year survival for those with and without cTnT elevation was 86.9% and 93.2%, respectively. By multivariate analysis, an elevation in cTnT after PCI was an independent predictor of increased long-term mortality. A doubling in the post-PCI cTnT was associated with a partial hazard ratio of 1.20 (95% confidence interval 1.02 to 1.40; p = 0.023).

CONCLUSIONS: An isolated minor elevation in cTnT after PCI provides long-term prognostic information regarding mortality and myocardial infarction.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CK-MB = creatine kinase-MB   CRP = C-reactive protein   cTnT = cardiac troponin T   MI = myocardial infarction   PCI = percutaneous coronary intervention

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