Author + information
- Received March 26, 2019
- Revision received July 2, 2019
- Accepted July 5, 2019
- Published online October 7, 2019.
- Hector M. Garcia-Garcia, MD, PhDa,b,∗ (, )
- Eugène P. McFadden, MD, PhDc,
- Clemens von Birgelen, MD, PhDd,
- Tessa Rademaker-Havinga, BSc, MSca,
- Ernest Spitzer, MDa,e,
- Neal S. Kleiman, MDf,
- David J. Cohen, MDg,
- Kevin F. Kennedy, MSg,
- Edoardo Camenzind, MDh,
- Laura Mauri, MDi,
- Philippe Gabriel Steg, MDj,k,
- William Wijns, MDl,
- Sigmund Silber, MDm,
- Gerrit-Anne van Es, PhDa,
- Patrick W. Serruys, MD, PhDn,
- Stephan Windecker, MDo,
- Donald Cutlip, MDp,q and
- Pascal Vranckx, MD, PhDr
- aCardialysis, Rotterdam, the Netherlands
- bInterventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
- cInterventional Cardiology, Cork University Hospital, Cork, Ireland
- dDepartment of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
- eDepartment of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
- fInterventional Cardiology, Houston Methodist DeBakey, Houston, Texas
- gMid America Heart Institute, University of Missouri, Kansas City, Missouri
- hUniversity of Geneva, Geneva, Switzerland
- iDivision of Cardiovascular Medicine, Baim Institute for Clinical Research, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- jFACT, DHU FIRE, Département de Cardiologie, INSERM U-1148, Université Paris Diderot, Paris, France
- kNational Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, United Kingdom
- lCardiology Department, Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium
- mDepartment of Cardiology, Heart Centre at the Isar, Munich, Germany
- nCentre for International Cardiovascular Health, Imperial College London, London, United Kingdom
- oBern University Hospital, Bern, Switzerland
- pBaim Institute for Clinical Research, Boston, Massachusetts
- qBeth Israel Deaconess Medical Center, Boston, Massachusetts
- rDepartment of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis & Faculty of Medicine and Life Sciences Hasselt University, Hasselt, Belgium
- ↵∗Address for correspondence:
Dr. Hector M. Garcia-Garcia, Division of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010.
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.
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.
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.
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 × the upper limit of normal (ULN) and cTn ≥35 × ULN, while 92% had both CK-MB <5 × ULN and cTn <35 × ULN. Among patients with CK-MB ≥5 × ULN (n = 315), 212 (67.3%) also had cTn ≥35 × ULN. Conversely, 390 of patients (64.8%) who had cTn ≥35 × ULN did not have CK-MB ≥5 × ULN. A total of 259 patients (1.9%) died at 1 year; 20 (7.7%) had CK-MB ≥5 × ULN, and 23 (8.8%) had cTn ≥35 × 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.
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.
This work was supported by Cardialysis. Dr. von Birgelen has received institutional research grants from Biotronik, Boston Scientific, and Medtronic. Dr. Steg has received research grants from Bayer, Merck, Sanofi, and Servier; and has received speaking or consulting fees from Amarin, Amgen, AstraZeneca, Bayer/Janssen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Merck Novartis, Pfizer, Regeneron, Sanofi, and Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 26, 2019.
- Revision received July 2, 2019.
- Accepted July 5, 2019.
- 2019 American College of Cardiology Foundation
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