Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention.

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Citation: Jacc: Cardiovascular Interventions. 12(19):1954-1962, 2019 10 14.PMID: 31601389Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Angina, Stable/th [Therapy] | *Creatine Kinase, MB Form/bl [Blood] | *Percutaneous Coronary Intervention/mo [Mortality] | *Troponin T/bl [Blood] | Aged | Angina, Stable/bl [Blood] | Angina, Stable/di [Diagnosis] | Angina, Stable/mo [Mortality] | Biomarkers/bl [Blood] | Drug-Eluting Stents | Female | Humans | Male | Middle Aged | Percutaneous Coronary Intervention/ae [Adverse Effects] | Percutaneous Coronary Intervention/is [Instrumentation] | Risk Assessment | Risk Factors | Time Factors | Treatment Outcome | Up-RegulationYear: 2019Local holdings: Available online through MWHC library: 2008 - presentISSN:
  • 1936-8798
Name of journal: JACC. Cardiovascular interventionsAbstract: 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.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. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.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.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.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.All authors: Camenzind E, Cohen DJ, Cutlip D, Garcia-Garcia HM, Kennedy KF, Kleiman NS, Mauri L, McFadden EP, Rademaker-Havinga T, Serruys PW, Silber S, Spitzer E, Steg PG, van Es GA, von Birgelen C, Vranckx P, Wijns W, Windecker SOriginally published: Jacc: Cardiovascular Interventions. 12(19):1954-1962, 2019 Oct 14.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-11-05
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31601389 Available 31601389

Available online through MWHC library: 2008 - present

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.

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. Copyright (c) 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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.

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.

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.

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