Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions.
- Koskinas KC From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.).
- Ndrepepa G Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.).
- Räber L From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.).
- Karagiannis A CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland (A.K., D.H.).
- Kufner S Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.).
- Zanchin T From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.).
- Hieber J Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.).
- Hunziker L From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.).
- Mayer K Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.).
- Byrne RA Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.).
- Heg D CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland (A.K., D.H.).
- Windecker S From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.).
- Kastrati A Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany (G.N., S.K., J.H., K.M., R.A.B., A.K.).
- 2018-12-15
Published in:
- Circulation. Cardiovascular interventions. - 2018
coronary artery disease
myocardial infarction
prognosis
troponin
Aged
Biomarkers
Coronary Angiography
Coronary Artery Disease
Coronary Occlusion
Coronary Restenosis
Female
Germany
Humans
Male
Middle Aged
Myocardial Infarction
Percutaneous Coronary Intervention
Retrospective Studies
Risk Assessment
Risk Factors
Switzerland
Time Factors
Treatment Outcome
Troponin T
English
BACKGROUND
The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions.
METHODS AND RESULTS
We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT >70× upper reference limit (URL) in patients with nonelevated (≤1× URL) baseline levels; or incremental increase >70× URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n=140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51-6.68; P<0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50-7.11; P<0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was >10×URL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin.
CONCLUSIONS
In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10× URL) in this cohort.
The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions.
METHODS AND RESULTS
We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT >70× upper reference limit (URL) in patients with nonelevated (≤1× URL) baseline levels; or incremental increase >70× URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n=140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51-6.68; P<0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50-7.11; P<0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was >10×URL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin.
CONCLUSIONS
In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10× URL) in this cohort.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1161/CIRCINTERVENTIONS.118.006752
- PMID 30545257
- Persistent URL
- https://sonar.ch/global/documents/278835
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