Thomas Zanchin1, Lorenz Räber1, Konstantinos C Koskinas1, Raffaele Piccolo1, Peter Jüni1, Thomas Pilgrim1, Stefan Stortecky1, Ahmed A Khattab1, Peter Wenaweser1, Stefan Bloechlinger1, Aris Moschovitis1, Andre Frenk1, Christina Moro1, Bernhard Meier1, Georg M Fiedler1, Dik Heg1, Stephan Windecker2. 1. From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.). 2. From the Department of Cardiology, Bern University Hospital, Switzerland (T.Z., L.R., K.C.K., R.P., T.P., S.S., A.A.K., P.W., S.B., A.M., A.F., C.M., B.M., S.W.); Applied Health Research Centre, St Michael's Hospital, University of Toronto, Canada (P.J.); Center for Laboratory Medicine, Inselspital, University Hospital Bern, Switzerland (G.M.F.); and Institute of Social and Preventive Medicine, University of Bern, Switzerland (D.H.). stephan.windecker@insel.ch.
Abstract
BACKGROUND: Cardiac troponin detected by new-generation, highly sensitive assays predicts clinical outcomes among patients with stable coronary artery disease (SCAD) treated medically. The prognostic value of baseline high-sensitivity cardiac troponin T (hs-cTnT) elevation in SCAD patients undergoing elective percutaneous coronary interventions is not well established. This study assessed the association of preprocedural levels of hs-cTnT with 1-year clinical outcomes among SCAD patients undergoing percutaneous coronary intervention. METHODS AND RESULTS: Between 2010 and 2014, 6974 consecutive patients were prospectively enrolled in the Bern Percutaneous Coronary Interventions Registry. Among patients with SCAD (n=2029), 527 (26%) had elevated preprocedural hs-cTnT above the upper reference limit of 14 ng/L. The primary end point, mortality within 1 year, occurred in 20 patients (1.4%) with normal hs-cTnT versus 39 patients (7.7%) with elevated baseline hs-cTnT (P<0.001). Patients with elevated hs-cTnT had increased risks of all-cause (hazard ratio 5.73; 95% confidence intervals 3.34-9.83; P<0.001) and cardiac mortality (hazard ratio 4.68; 95% confidence interval 2.12-10.31; P<0.001). Preprocedural hs-TnT elevation remained an independent predictor of 1-year mortality after adjustment for relevant risk factors, including age, sex, and renal failure (adjusted hazard ratio 2.08; 95% confidence interval 1.10-3.92; P=0.024). A graded mortality risk was observed across higher tertiles of elevated preprocedural hs-cTnT, but not among patients with hs-cTnT below the upper reference limit. CONCLUSIONS: Preprocedural elevation of hs-cTnT is observed in one fourth of SCAD patients undergoing elective percutaneous coronary intervention. Increased levels of preprocedural hs-cTnT are proportionally related to the risk of death and emerged as independent predictors of all-cause mortality within 1 year. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02241291.
BACKGROUND: Cardiac troponin detected by new-generation, highly sensitive assays predicts clinical outcomes among patients with stable coronary artery disease (SCAD) treated medically. The prognostic value of baseline high-sensitivity cardiac troponin T (hs-cTnT) elevation in SCAD patients undergoing elective percutaneous coronary interventions is not well established. This study assessed the association of preprocedural levels of hs-cTnT with 1-year clinical outcomes among SCAD patients undergoing percutaneous coronary intervention. METHODS AND RESULTS: Between 2010 and 2014, 6974 consecutive patients were prospectively enrolled in the Bern Percutaneous Coronary Interventions Registry. Among patients with SCAD (n=2029), 527 (26%) had elevated preprocedural hs-cTnT above the upper reference limit of 14 ng/L. The primary end point, mortality within 1 year, occurred in 20 patients (1.4%) with normal hs-cTnT versus 39 patients (7.7%) with elevated baseline hs-cTnT (P<0.001). Patients with elevated hs-cTnT had increased risks of all-cause (hazard ratio 5.73; 95% confidence intervals 3.34-9.83; P<0.001) and cardiac mortality (hazard ratio 4.68; 95% confidence interval 2.12-10.31; P<0.001). Preprocedural hs-TnT elevation remained an independent predictor of 1-year mortality after adjustment for relevant risk factors, including age, sex, and renal failure (adjusted hazard ratio 2.08; 95% confidence interval 1.10-3.92; P=0.024). A graded mortality risk was observed across higher tertiles of elevated preprocedural hs-cTnT, but not among patients with hs-cTnT below the upper reference limit. CONCLUSIONS: Preprocedural elevation of hs-cTnT is observed in one fourth of SCAD patients undergoing elective percutaneous coronary intervention. Increased levels of preprocedural hs-cTnT are proportionally related to the risk of death and emerged as independent predictors of all-cause mortality within 1 year. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02241291.
Authors: Johannes Mair; Allan Jaffe; Bertil Lindahl; Nicholas Mills; Martin Möckel; Louise Cullen; Evangelos Giannitsis; Ola Hammarsten; Kurt Huber; Konstantin Krychtiuk; Christian Mueller; Kristian Thygesen Journal: Biomarkers Date: 2022-05-26 Impact factor: 2.663
Authors: Brigitta Gahl; Volkhard Göber; Ayodele Odutayo; Hendrik T Tevaearai Stahel; Bruno R da Costa; Stephan M Jakob; G Martin Fiedler; Olivia Chan; Thierry P Carrel; Peter Jüni Journal: J Am Heart Assoc Date: 2018-02-27 Impact factor: 5.501