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. 2022 Dec 28;12(1):244.
doi: 10.3390/jcm12010244.

Peri-Procedural Troponin Elevation after Percutaneous Coronary Intervention for Left Main Coronary Artery Disease

Wojciech Jan Skorupski  1 , Marta Kałużna-Oleksy  1 , Przemysław Mitkowski  1 , Włodzimierz Skorupski  1 , Stefan Grajek  1 , Małgorzata Pyda  1 , Aleksander Araszkiewicz  1 , Maciej Lesiak  1 , Marek Grygier  1
Affiliations

Peri-Procedural Troponin Elevation after Percutaneous Coronary Intervention for Left Main Coronary Artery Disease

Wojciech Jan Skorupski et al. J Clin Med. .

Abstract

Left main (LM) percutaneous coronary interventions (PCI) are challenging and highly invasive procedures. Periprocedural myocardial injury (Troponin (Tn) elevation > 99th percentile) is frequently detected after LM PCI, being identified even in up to 67% of patients. However, the prognostic implications of periprocedural Tn elevation after LM PCI remain controversial. We aim to assess the impact and prognostic significance of the periprocedural troponin elevation on long-term outcomes in patients undergoing LM PCI in a real-world setting. Consecutive 673 patients who underwent LM PCI in our department between January 2015 to February 2021 were included in a prospective registry. The first group consisted of 323 patients with major cardiac Troponin I elevation defined as an elevation of Tn values > 5× the 99th percentile in patients with normal baseline values or post-procedure Tn rise by >20% in patients with elevated pre-procedure Tn in whom the Tn level was stable or falling (based on the fourth universal definition of myocardial infarction). The second group consisted of patients without major cardiac Troponin I elevation. Seven-year long-term all-cause mortality was not higher in the group with major Tn elevation (36.9% vs. 40.6%; p = 0.818). Naturally, periprocedural myocardial infarction was diagnosed only in patients from groups with major Tn elevation (4.9% of all patients). In-hospital death and other periprocedural complications did not differ significantly between the two study groups. The adjusted HRs for mortality post-PCI in patients with a periprocedural myocardial infarction were not significant. Long-term mortality subanalysis for the group with criteria for cardiac procedural myocardial injury showed no significant differences (39.5% vs. 38.8%; p = 0.997). The occurrence of Tn elevation (>1×; >5×; >35× and >70× URL) after LM PCI was not associated with adverse long-term outcomes. The results of the study suggest that the isolated periprocedural troponin elevation is not clinically significant.

Keywords: coronary artery disease; left main; percutaneous coronary intervention; periprocedural myocardial injury; troponin elevation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart presenting population size and definitions.
Figure 2
Figure 2
Kaplan-Meier analysis of all-cause mortality: major Tn elevation vs. NO major Tn elevation (based on PCI-related myocardial infarction definition from the fourth universal definition of myocardial infarction).
Figure 3
Figure 3
Kaplan-Meier analysis of all-cause mortality: Periprocedural myocardial injury vs. NO periprocedural myocardial injury (Fourth Universal Definition of Myocardial Infarction).
Figure 4
Figure 4
Kaplan-Meier curves for all-cause mortality according to different cutoffs of postprocedural Troponin levels.
Figure 5
Figure 5
Kaplan-Meier curves for all-cause mortality according to different cutoffs of postprocedural CK-MB mass levels.
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