Predictive Value of Elevated Protein Levels in Post-PCI Cardiac Muscles Studied


May 13, 2011—Dmitriy N. Feldman, MD, et al published findings from a meta-analysis of the prognostic value of cardiac troponin-i (cTnI) or cardiac troponin-T (cTnT) elevation after nonemergent percutaneous coronary intervention (PCI). The study is available online ahead of print in Catheterization and Cardiovascular Interventions.

According to the investigators, the aim of this meta-analysis was to assess the prevalence and prognostic value regarding mortality of cTnI or cTnT elevations after nonemergent PCI in a large number of cohort/registry studies. They noted that routine cardiac troponin measurement after elective PCI has been controversial among interventionists and that recent studies have provided conflicting data in regard to the predictive value of cTnI and cTnT elevation after nonemergent PCI.

The investigators conducted electronic and manual searches of all published studies reporting on the prognostic impact of cTnI or cTnT elevation after elective PCI, and a meta-analysis was performed with all-cause mortality at follow-up as the primary endpoint.

As detailed in Catheterization and Cardiovascular Interventions, the investigators identified 22 studies involving 22,353 patients that were published between 1998 and 2009. Postprocedural cTnI and cTnT were elevated in 34.3% and 25.9% of patients, respectively. The follow-up period ranged from 3 to 67 months (mean, 17.7 ± 14.9 mo). The results showed no heterogeneity among the trials (Q-test, 25.39; I², 17%; P = .23). No publication bias was detected (Egger's test, P = .16). The long-term all-cause mortality in patients with cTnI or cTnT elevation after PCI (5.8%) was significantly higher when compared to patients without cTnI or cTnT elevation (4.4%) (odds ratio, 1.45; 95% confidence interval, 1.22–1.72; P < .01). In addition, the postprocedural composite adverse clinical events of all-cause mortality or myocardial infarction in patients with cTnI or cTnT elevation after PCI (9.2%) was significantly higher when compared to patients without cTnI or cTnT elevation (5.3%) (odds ratio, 1.77; 95% confidence interval, 1.48–2.11; P < .01).

The investigators concluded that the current meta-analysis indicates that cTnI or cTnT elevation after nonemergent PCI is indicative of an increase in long-term all-cause mortality, as well as the composite adverse events of all-cause mortality and myocardial infarction. They advised that efforts to routinely monitor periprocedural cTn levels along with more intensive outpatient monitoring/treatment of patients with cTn elevations may help to improve the long-term adverse outcomes in these patients after nonemergent PCI.