Abstract
Cardiac troponin-I (cTnI) and -T (cTnT) are sensitive and specific markers of myocardial injury. However, the role of increased cTnI and cTnT in percutaneous coronary intervention (PCI)-related myocardial injury remains controversial. In this prospective, single-center and double-blind study, we aimed to determine the diagnostic and prognostic value of cTnI as well as cTnT (cTns) in PCI-related myocardial injury in a Chinese population. A total of 1,008 patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI. All patients were followed up for 26±9 months to observe the incidence of major adverse cardiac events (MACEs). Our results showed that post-PCI cTnI and/or cTnT levels were increased to more than the 99th percentile upper reference limit (URL) in 133 (13.2%) patients, among which 22 (2.2%) were more than 5 × 99th percentile URL. By univariate analysis, an elevation in cTns after PCI was not an independent predictor of increased MACEs, HR 1.35 (P = 0.33, 95%CI: 0.74–2.46). In conclusion, our data demonstrate that the incidence of PCI-related myocardial injury is not common in a Chinese population and minor elevated cTns levels may not be a sensitive prognostic marker for MACEs.
Highlights
According to the universal definition of myocardial infarction (MI), the increased level of cardiac troponins from normal baseline value to above the 99th percentile upper reference limit (URL) could be assumed as an indicator for percutaneous coronary intervention (PCI)-myocardial necrosis
A total of 2,192 patients fulfilled the inclusion criteria but 701 (27%) patients were excluded because of missing Cardiac troponin-I (cTnI) or cTnT or its baseline levels . 99th percentile URL; 483 (19%) patients were excluded for acute STsegment elevation myocardial infarction requiring emergency intervention
The non- PCI-related myocardial injury (PMI) group was defined as cTnT levels, 0.1 ng/mL and cTnI, 0.5 ng/mL, the PMI group was defined as cTnT . 0.1 ng/mL (99th percentile URL), or cTnI . 0.5 ng/mL (99th percentile URL)
Summary
According to the universal definition of myocardial infarction (MI), the increased level of cardiac troponins (cTns) from normal baseline value to above the 99th percentile upper reference limit (URL) could be assumed as an indicator for PCI-myocardial necrosis. Many studies have demonstrated that significant elevation of CK-MB levels is associated with reduced long-term survival rate of post-PCI patients[11,12,13]. Previous studies showed no prognostic role of increased post-PCI cTnI levels for mortality in ACS patients[14,15,16,17,18,19,20]. Recent reports have suggested that elevated cTnI level may be a predictor of long-term mortality[21,22,23,24,25] The aim of this prospective, single-center and double-blind study was to determine the diagnostic and prognostic value of cTnI as well as cTnT in PCI-related myocardial injury in a Chinese population
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