Author + information
- Roberto Muniz Ferreira, MD, PhD∗ (, )
- Nelson Albuquerque de Souza e Silva, MD, PhD and
- Lúcia Helena Alvares Salis, MD, PhD
- ↵∗Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil 21941-913
Ndrepepa et al. (1) proposed to study whether the prognostic value of post-procedural high-sensitivity troponin T (hs-TnT) elevation after elective percutaneous coronary interventions (PCI) was related to baseline hs-TnT levels. Their results suggested that only the pre-procedural hs-TnT was predictive of 3-year all-cause mortality. However, the following observations need to be considered:
1. Previous pre-procedural medications were not reported and could have influenced both the baseline and post-PCI hs-TnT levels.
2. Procedural complications such as bleeding and renal toxicity are strongly associated with biomarker elevation and prognosis in this context (2). The authors failed to account for the prevalence of these potentially confounding events throughout the study.
3. Medication usage and additional coronary interventions throughout the follow-up period are other variables that could have influenced mortality. The lack of this information needs to be acknowledged as another study limitation.
4. The authors state (pages 2264 and 2265) (1) that among those subjects with normal pre-procedural hs-TnT values, post-PCI elevation was associated with an increased risk of mortality on follow-up (univariate hazard ratio: 2.38; 95% confidence interval: 1.03 to 5.54; p = 0.043). However, the hazard ratios presented along the mortality curves in Figure 1 are reversed between the groups of patients with and without elevated baseline hs-TnT levels.
5. According to the data in Table 5, when only the patients without baseline elevated hs-TnT are considered, any post-PCI biomarker elevation was significantly related to greater mortality (6 of 742 vs. 54 of 2,721 patients; p = 0.029).
Perhaps the most important message conveyed by the findings of this large-scale study is that, in the context of elective PCI, baseline hs-TnT may perform as a significant predictor of mortality on follow-up regardless of post-procedural elevation. However, the 77.6% prevalence of post-PCI elevation must be appreciated, as previous studies have also found similar prognostic value associated with this finding (3).
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
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