Predictive value of cardiac troponin increase after percutaneous coronary intervention: is it just a marker of disease complexity?
Authors: Chevalier B C ,   e-ULTIMASTER investigators
Published: October 2021

Abstract

Background/Introduction
Peri-procedural myocardial infarction (MI) following percutaneous coronary intervention (PCI) is supposed to have an impact on outcome after PCI for stable coronary disease, but the rate of this event is highly dependent on their definitions. Most of the recently proposed definitions are based on cardiac troponin (hs-cTn) rise.

Purpose
The purpose of this analysis is to explore the impact of hs-cTn increase on mortality and cardiac events after PCI for chronic coronary disease with baseline normal value of hs-cTn.

Methods
e-ULTIMASTER is a large, all-comers registry that enrolled 37,198 patients worldwide who underwent PCI with a thin strut, cobalt chromium sirolimus-eluting stent. Risk-based monitoring was performed and all primary endpoint related events were adjudicated. Clinical follow-up was performed at 3 months and 1 year, with primary endpoint of target lesion failure (TLF) at 1 year. For this analysis, we selected patients with stable angina, silent ischemia, or unstable angina with normal hs-cTn values at baseline. We defined the cut-off value of hs-cTn level as the following: &lt;10, 10–35, ≥35 upper limit of normal (ULN). To adjust for differences in baseline characteristics, a propensity analysis (inverse probability of treatment weights, IPTW) was done. Picture 1 shows variables included in the propensity score and differences between the groups (cTn&lt;10 vs cTn 10–35 and cTn&lt;10 vs cTn≥35) before and after matching.

Results
The number of patients in each subgroup is: hs-cTn&lt;10 (n=3178), 10–35 (n=492), ≥35 (n=303). The mean age of each subgroup is respectively: 66.2; 68.1, 66.6 years (p&lt;0.01). Across the three hs-cTn level groups, many baseline patient characteristics were similar but several lesion and procedure characteristics were significantly different across the three groups including bifurcation lesions, calcification, N of lesions treated, N of stents implanted, total stent length and procedural complications.
The unadjusted and adjusted rates of 1-year clinical outcomes are presented in picture 2. All-cause or cardiac death were not increased in cTn≥35 group while there was a trend towards higher target lesion revascularization (TLR) and significantly higher stent thrombosis, majority of which (75% and 91% respectively) occurred during index hospitalization. There was a significantly higher rate of spontaneous MI in both groups with elevated hs-cTn.

Conclusion
Hs-cTn rise above 35 x ULN was not associated with cardiac or all-cause 1-year mortality. Significantly higher stent thrombosis and a trend towards higher TLR, observed in this group at 1-year, reflect procedure complications, based on the timing of event. When excluding peri-procedural MI in the matched analysis of outcomes, a significantly higher rate of spontaneous MI was observed in both groups with hs-cTn increase. The findings of this analysis suggest that hs-cTn rise is a marker of patient/lesion complexity.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Terumo Picture 1. Baseline variables before/after matchingPicture 2. 1-year clinical outcomes