Prognostic value of troponin after elective percutaneous coronary intervention: A meta‐analysis

Nienhuis, Mark B.; Ottervanger, Jan Paul; Bilo, Henk J. G.; Dikkeschei, Bert D.; Zijlstra, Felix

doi:10.1002/ccd.21345

Cited by 163 publications

(128 citation statements)

References 48 publications

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“…1,2) A laboratory finding of PMI is defined as the release of cardiac troponin (cTn) > 5 × 99 th percentile of the upper reference limit, 3) and cTn elevation after PCI is associated with increased adverse cardiac events. [4][5][6][7] Distal embolization is one of the strongest contributors to PMI, and embolic particles are frequently observed during PCI. 1,8,9) The amount of microembolization is strongly related to the magnitude of cTn elevation, microvascular dysfunction, and worsening of cardiac function.…”

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confidence: 99%

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

et al. 2014

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SummaryPeriprocedural myocardial infarction (PMI) is one of the major complications of percutaneous coronary intervention (PCI). We investigated the influence of coronary plaque burden and characteristics on PMI using intravascular ultrasound (IVUS) with radiofrequency-based tissue characterization technology (iMAP). The study population consisted of 33 consecutive patients with stable angina pectoris who underwent PCI. IVUS images were recorded before and after PCI for offline analysis, and coronary flow reserve (CFR) was measured after PCI. PMI was defined as a post-PCI cardiac troponin T elevation > 5 × 99 th percentile of the upper reference limit (0.014 ng/mL). Plaque volume in patients with PMI (n = 12) was significantly greater than that in patients without PMI (n = 21) (240.4 ± 106.0 mm 3 versus 152.1 ± 76.9 mm 3 , P = 0.0096). The iMAP-IVUS analysis demonstrated that the fibrotic, lipidic, and necrotic tissue volume within culprit lesions were also greater in patients with PMI than in patients without PMI (129.4 ± 52.2 mm 3 versus 94.6 ± 40.8 mm , P = 0.0071, respectively). Multivariate logistic analysis demonstrated that necrotic tissue volume was the only independent predictor of PMI. Multiple regression analysis demonstrated that the post-PCI CFR values significantly correlated with percent plaque burden, and there were no correlations with the percent tissue burden of each plaque component. In conclusion, the iMAP-IVUS analyses demonstrate that necrotic tissue volume is a potent predictor of PMI. Microcirculatory disturbance after PCI is significantly influenced by percent plaque burden, regardless of plaque compositions. (Int Heart J 2014; 55: 391-396)

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confidence: 99%

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

et al. 2014

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“…Although occurring mostly silently, even minor postprocedural elevations of cardiac biomarkers have been associated with adverse outcomes 17, 18. Inflammation and platelet activation play a critical role in the pathogenesis of myocardial damage following coronary interventions 6, 7.…”

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confidence: 99%

Effects of the P‐Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention According to Timing of Infusion: Insights From the SELECT‐ACS Trial

Stähli

Gebhard

Duchatelle

et al. 2016

JAHA

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BackgroundThe Effects of the P‐Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention for Non‐ST‐Segment Elevation Myocardial Infarction (SELECT‐ACS) trial suggested beneficial effects of inclacumab, a monoclonal antibody directed against P‐selectin, on periprocedural myocardial damage. This study evaluated the effect of inclacumab on myocardial damage according to varying time intervals between study drug infusion and percutaneous coronary intervention (PCI).Methods and ResultsPatients (n=544) enrolled in the SELECT‐ACS trial and randomized to receive 1 infusion of placebo or inclacumab (5 or 20 mg/kg, administered between 1 and 24 hours before PCI) were divided according to the time interval between study drug infusion and PCI. The primary end point was the change in troponin I from baseline at 16 and 24 hours after PCI. In patients receiving inclacumab 20 mg/kg with a short (less than median) time interval between infusion and PCI, placebo‐adjusted geometric mean percent changes in troponin I, creatine kinase–myocardial band, and peak troponin I at 24 hours were −45.6% (P=0.005), −30.7% (P=0.01), and −37.3% (P=0.02), respectively. No significant changes were observed in patients with a long (greater than median) time interval between infusion and PCI. Placebo‐adjusted geometric mean percent changes in troponin I and creatine kinase–myocardial band were −43.5% (P=0.02) and −26.0% (P=0.07), respectively, when inclacumab 20 mg/kg was administered between 1 and 3 hours before PCI, whereas the drug had no effect with longer intervals.ConclusionsInclacumab 20 mg/kg significantly reduces myocardial damage after PCI in patients with non–ST‐segment elevation myocardial infarction, and benefits are larger when the infusion is administered <3 hours before PCI.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01327183.

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“…Troponin I elevation has been found in 16-73% of patients, and is associated with an increase in mortality as high as 45%, according to multiple meta-analyses. [8][9] . Levels above 5 times the 99th percentile predict an even worse outcome, and similar findings involving highsensitivity assays have also been described10.…”

Section: Discussionmentioning

confidence: 99%

Cardiac troponin T estimation post elective stent implantation and prediction of early and late outcomes

Baiju

Viswanathan

Kumar³

2017

Int J Res Med Sci

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Background: Coronary artery disease (CAD) is a major cause of mortality and morbidity. Per Cutaneous Interventions (PCI) is emerging as the mainstay of treatment for CAD. Periprocedural myocardial necrosis, which can range from a low-level elevation of cardiac biomarkers to a large myocardial infarction, is an important complication of PCI. There are conflicting reports regarding peri-procedural biomarker elevation and adverse outcome. It is in this context we have undertaken this study to assess the prognostic significance of cardiac troponin T elevation after elective stent implantation.Methods: The study population included 100 consecutive patients who underwent elective PCI with stent implantation in cardiology unit of Medical College, Trivandrum. Serial cardiac enzyme levels were measured in all patients undergoing the procedure. CPK was measured at 8 hrs, 16 hrs and 24 hrs and Troponin T was measured at 8hrs and 24 hrs. post PCI. In hospital events were documented and patients were on follow up for a period of 1 year. Primary endpoints of death, myocardial infarction, recurrent ischemia leading to revascularization were noted.Results: In our study population of 100 patients there were 87 males and 13 females. Among them 50% had unstable angina, 18% had exertional angina and 32% were post myocardial infarction patients. In this group of hundred patients 79% had single vessel disease, 18% had two vessels and 3% had triple vessel disease. A total of 103 stents were deployed. Mean CPK levels were CPK-1 (80.11+36.19), mean CPK-2 (83.91± 34.8) and mean CPK-3 (86.32+57.80). Mean Troponin T-1 was 0.04+0.1 and mean Troponin-2 was 0.06+0.145. In this study, we compared late onset angina with Troponin and CPK positivity and found that both Troponin-1 & Troponin-2 had significant correlation with late onset angina.Conclusions: Periprocedural Troponin T is more sensitive than CPK in predicting late events. Thrombus containing lesions and bifurcation lesions were significantly associated with elevation in Troponin T. No significant Troponin T elevations were noted in patients with diabetes mellitus and those containing calcified lesions. Drug eluting stents were associated with a relatively lesser Troponin T elevations but not statistically significant.

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Prognostic value of troponin after elective percutaneous coronary intervention: A meta‐analysis

Abstract: According to this meta-analysis, troponin elevation after elective PCI provides important prognostic information.

Cited by 163 publications

References 48 publications

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

Effects of the P‐Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention According to Timing of Infusion: Insights From the SELECT‐ACS Trial

Cardiac troponin T estimation post elective stent implantation and prediction of early and late outcomes

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