Author + information
- Received January 13, 2006
- Revision received April 20, 2006
- Accepted April 23, 2006
- Published online November 7, 2006.
- Abhiram Prasad, MD, FRCP, FACC⁎,⁎ (, )
- Mandeep Singh, MD, FACC⁎,
- Amir Lerman, MD, FACC⁎,
- Ryan J. Lennon, MS†,
- David R. Holmes Jr, MD, FACC⁎ and
- Charanjit S. Rihal, MD, FACC⁎
- ↵⁎Reprint requests and correspondence:
Dr. Abhiram Prasad, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Objectives The aim of this study was to evaluate whether, in patients with normal post-procedure CK-MB, an isolated elevation in cardiac troponin T (cTnT) predicts long-term survival.
Background Cardiac troponin T is a sensitive and specific marker of myonecrosis. There is little known about the incidence and prognostic significance of an isolated elevation of cTnT without a rise in creatine kinase (CK)-MB following PCI.
Methods We evaluated the outcomes of 1,949 patients from the Mayo Clinic registry who had normal pre-procedure cTnT and CK-MB, required nonemergency percutaneous coronary intervention (PCI), and had normal CK-MB after the procedure.
Results An elevation in cTnT (cTnT+) was observed in 383 patients (19.6%) (median 0.04 ng/ml, interquartile range 0.03 to 0.06 ng/ml). The TnT+ status was associated with adverse clinical and angiographic characteristics, and multivessel PCI. Over the median follow-up duration of 26 months, mortality (p < 0.001) and the combined rate of death and myocardial infarction (p = 0.004) were significantly higher in cTnT+ patients. Estimated 3-year survival for those with and without cTnT elevation was 86.9% and 93.2%, respectively. By multivariate analysis, an elevation in cTnT after PCI was an independent predictor of increased long-term mortality. A doubling in the post-PCI cTnT was associated with a partial hazard ratio of 1.20 (95% confidence interval 1.02 to 1.40; p = 0.023).
Conclusions An isolated minor elevation in cTnT after PCI provides long-term prognostic information regarding mortality and myocardial infarction.
- Received January 13, 2006.
- Revision received April 20, 2006.
- Accepted April 23, 2006.
- American College of Cardiology Foundation