536 Prognostic Implications of Post-Percutaneous Intervention Troponin Rise in Non-ST Elevation Myocardial and Unstable Angina Patients

Abstract

Troponin elevation after percutaneous coronary intervention (PCI) is common but its prognostic significance remains uncertain. We aimed to study the relationship between the level of troponin elevation post-PCI and adverse events in non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) patients. A retrospective analysis of all patients who underwent PCI for NSTEMI and UA between 2014-2018 was carried out. Primary outcome was major adverse cardiovascular events (MACE) in 12 months. Contingency analysis for MACE with different post-PCI troponin values was carried out. Registry analysis revealed that 1506 patients with mean age of 66.3±23.06 years with a male predominance (74.8 %) underwent PCI for NSTEMI and UA presentations. Contingency analysis of MACE by post-PCI troponin at different cut-offs revealed that in the NSTEMI patients the post-PCI troponin level did not increase MACE and remained steady around 11% until the troponin level was >40000 ng/L when MACE increased to 15%. However, in UA patients, the MACE was steady around 7% till the troponin level was >1000 ng/L, after which the MACE increased steadily to 25% when troponin was >10000 ng/L. Our results suggest that post-procedure troponin rise >1000 ng/L was associated with higher rate of MACE in UA patients. There was no obvious association between level of troponin and MACE rate in NSTEMI patients, until the level was >40,000. The clinical significance and indeed the necessity of routine post-PCI troponin measurement requires further review.