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Title: | Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention | Authors: | Garcia-Garcia, Hector M. McFadden, Eugene 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 |
Issue Date: | 2019 | Publisher: | ELSEVIER SCIENCE INC | Source: | JACC-CARDIOVASCULAR INTERVENTIONS, 12(19), p. 1954-1962 | 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 x the upper limit of normal (ULN) and cTn >= 35 x ULN, while 92% had both CK-MB <5 x ULN and cTn <35 x ULN. Among patients with CK-MB >= 5 x ULN (n = 315), 212 (67.3%) also had cTn >= 35 x ULN. Conversely, 390 of patients (64.8%) who had cTn >= 35 x ULN did not have CK-MB >= 5 x ULN. A total of 259 patients (1.9%) died at 1 year; 20 (7.7%) had CK-MB >= 5 x ULN, and 23 (8.8%) had cTn >= 35 x 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. (C) 2019 by the American College of Cardiology Foundation. | Notes: | [Garcia-Garcia, Hector M.; Rademaker-Havinga, Tessa; Spitzer, Ernest; van Es, Gerrit-Anne] Cardialysis, Rotterdam, Netherlands. [Garcia-Garcia, Hector M.] MedStar Washington Hosp Ctr, Intervent Cardiol, Washington, DC USA. [McFadden, Eugene P.] Cork Univ Hosp, Intervent Cardiol, Cork, Ireland. [von Birgelen, Clemens] Med Spectrum Twente, Dept Cardiol, Thoraxctr Twente, Enschede, Netherlands. [Spitzer, Ernest] Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands. [Kleiman, Neal S.] Houston Methodist DeBakey, Intervent Cardiol, Houston, TX USA. [Cohen, David J.; Kennedy, Kevin F.] Univ Missouri, Mid Amer Heart Inst, Kansas City, MO 64110 USA. [Camenzind, Edoardo] Univ Geneva, Geneva, Switzerland. [Mauri, Laura] Brigham & Womens Hosp, Div Cardiovasc Med, Baim Inst Clin Res, 75 Francis St, Boston, MA 02115 USA. [Mauri, Laura] Harvard Med Sch, Boston, MA 02115 USA. [Steg, Philippe Gabriel] Univ Paris Diderot, Dept Cardiol, INSERM, FACT,DHU FIRE,U1148, Paris, France. [Steg, Philippe Gabriel] Royal Brompton Hosp, Imperial Coll, Natl Heart & Lung Inst, London, England. [Wijns, William] Onze Lieve Vrouw Hosp, Cardiol Dept, Cardiovasc Res Ctr Aalst, Aalst, Belgium. [Silber, Sigmund] Heart Ctr Isar, Dept Cardiol, Munich, Germany. [Serruys, Patrick W.] Imperial Coll London, Ctr Int Cardiovasc Hlth, London, England. [Windecker, Stephan] Bern Univ Hosp, Bern, Switzerland. [Cutlip, Donald] Baim Inst Clin Res, Boston, MA USA. [Cutlip, Donald] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA. [Vranckx, Pascal] Jessa Ziekenhuis, Hartctr Hasselt, Dept Cardiol & Crit Care Med, Hasselt, Belgium. [Vranckx, Pascal] Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium. | Keywords: | cardiac troponin; CK-MB; drug-eluting stent; percutaneous coronary intervention; mortality;cardiac troponin; CK-MB; drug-eluting stent; percutaneous coronary intervention; mortality | Document URI: | http://hdl.handle.net/1942/29975 | ISSN: | 1936-8798 | e-ISSN: | 1876-7605 | DOI: | 10.1016/j.jcin.2019.07.014 | ISI #: | 000489226100015 | Rights: | 2019 by the American College of Cardiology Foundation. Published by Elsevier. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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