Elevated Troponin I after Implantation of Drug-Eluting Stents: Incidence, Predictors, and Prognostic Value

Abstract

Background and Objectives: The presence of elevated troponin after percutaneous coronary intervention (PCI) is considered to reflect irreversible myocardial injury. However, its prognostic value remains unclear. The purpose of this study was to investigate the incidence, risk factors, and clinical outcomes of troponin I (TnI) elevation after the implantation of drug-eluting stent (DES). Subjects and Methods: We performed a retrospective analysis of 335 patients who had undergone PCI with DES. Patients who had acute coronary syndrome with elevated TnI levels before PCI were excluded. TnI levels were measured 6 and 24 hours after PCI. Results: Baseline clinical characteristics were similar in the elevated TnI and normal TnI groups. Elevated postprocedural TnI (>1.5 ng/mL) occurred in 52 patients (15.5%). Univariate analysis revealed that the clinically significant variables were multi-vessel disease (p<0.001), multiple stent implantation (p=0.003), total stent length (p=0.001), side-branch occlusion (p<0.001), and bifurcation lesion (p=0.003). Multivariate analysis indicated that the independent predictors of elevated TnI after DES implantation were multi-vessel disease (p=0.019), side-branch occlusion (p=0.001), and bifurcation (p= 0.011). There were no significant differences in major adverse cardiovascular events between the elevated TnI and normal TnI groups (p=0.461). Conclusion: Multi-vessel disease, side-branch occlusion, and bifurcation were independent predictors of elevated TnI following DES implantation. The elevation of TnI after successful PCI with DES was not associated with worse 400-day clinical outcomes. (Korean Circ J 2008;38:12-16)