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Although cardiac troponin (cTn) elevation
is associated with periprocedural complications
during percutaneous coronary intervention (PCI)
in the setting of acute coronary syndromes, the
prevalence and prognostic significance of
preprocedural cTn elevation among patients with
stable coronary artery disease undergoing PCI
are unknown.
Between July 2004 and September 2006, 7592 consecutive
patients who underwent attempted stent placement
at 47 hospitals throughout the United States
were enrolled in a prospective multicenter
registry. The authors analyzed the frequency of
an elevated cTn immediately before PCI and its
relationship to in-hospital and 1-year outcomes
among patients who underwent PCI for either
stable angina or a positive stress test. Among
the stable coronary artery disease population (n
= 2382, 31.4%), 142 (6.0%) had a cTn level above
the upper limit of normal before the procedure.
Compared with patients who had normal baseline
cTn, patients with elevated cTn had a higher
rate of in-hospital death or myocardial
infarction (13.4% versus 5.6%; P<0.001) and a
trend toward higher rates of urgent repeat PCI
(1.4% versus 0.2%; P = 0.06). In multivariable
analyses adjusted for demographic, clinical,
angiographic, and procedural factors, baseline
cTn elevation remained independently associated
with the composite of death or myocardial
infarction at hospital discharge (odds ratio,
2.1; 95% confidence interval, 1.2 to 3.8; P =
0.01) and at the 1-year follow-up (odds ratio,
2.0; 95% confidence interval, 1.2 to 3.3; P =
0.005).
Baseline elevation of cTn is relatively common among
patients with stable coronary artery disease
undergoing PCI and is an independent prognostic
indicator of ischemic complications. If these
data are confirmed in future studies,
consideration should be given to routine testing
of cTn before performance of PCI in this patient
population.
Circulation. 2008;118:632-638
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