Prognostic Significance of Elevated Troponin Levels After PCI

Many studies have documented an association between elevated CK or CK-MB levels after PCI and increased risk of adverse cardiac events at intermediate- and long-term follow-up (1). However, there has been inconsistency as to whether even modest elevations in CK or CK-MB are associated with adverse outcomes. Some studies have shown a direct relationship between the degree of periprocedural myonecrosis and the risk of long-term complications (Fig. 3) (2), whereas others have found increased complications only with large elevations in cardiac enzymes. In one meta-analysis, a linear association between CK-MB elevation post-PCI and 6-mo mortality was demonstrated (28). Although absolute mortality rates are higher after spontaneous MI, the relative increase in mortality for increasing levels of CK-MB elevation are similar for periprocedural and spontaneous MI (Fig. 4) (28). It remains unclear whether there is a direct causal relationship between peri-procedural myonecrosis and long-term complications, or whether cardiac marker elevations are simply a marker for high-risk lesion, vessel, or patient characteristics.

Table 2 provides the studies that have evaluated the prognostic significance of elevated levels of troponin after PCI. Most, but not all, studies found a significant association between troponin results and adverse outcomes (Fig. 5). In some studies, the association

Death Ml CABG PCI Composite

Fig. 3. Point estimates and 95% confidence intervals for frequency of cardiac events through 6 mo after PCI stratified by postprocedural concentration of CK-MB. PCI, percutaneous coronary intervention.

Death Ml CABG PCI Composite

Fig. 3. Point estimates and 95% confidence intervals for frequency of cardiac events through 6 mo after PCI stratified by postprocedural concentration of CK-MB. PCI, percutaneous coronary intervention.

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