• Joerg Herrmann, Ryan J Lennon, Allan S Jaffe, David R Holmes, Charanjit S Rihal, and Abhiram Prasad.
• From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George's, University of London, London, United Kingdom (A.P.).
• Circ Cardiovasc Interv. 2014 Aug 1; 7 (4): 533-42.

BackgroundThere is controversy about the diagnostic and prognostic significance of percutaneous coronary intervention-related myocardial infarction, especially with the use of cardiac troponin T (cTnT). This analysis was designed to address the question of the presence and the level of a prognostic cTnT threshold.Methods And ResultsWe evaluated 5268 consecutive patients who underwent nonemergent percutaneous coronary intervention between 2000 and 2009 with a preprocedural cTnT level below the upper limit of normal (ULN, ≤0.01 ng/mL). Postprocedural cTnT and creatine kinase-MB mass levels (ULN, 6.7 ng/mL in men and 3.8 ng/mL in women) were found to be associated with 3-month mortality in Cox proportional hazard models (hazard ratio per doubling of cTnT, 1.24; 95% confidence interval, 1.08-1.43; P=0.003 and hazard ratio per doubling of creatine kinase-MB, 1.30; 95% confidence interval, 1.05-1.60; P=0.018), adjusted for the Mayo Clinic risk scores for in-hospital and postdischarge mortality. The optimal prognostic threshold for 3-month mortality was 25× ULN for cTnT (hazard ratio, 4.53; 99% confidence interval, 1.59-12.9; P<0.001), which provided similar information as a value of 5× ULN for creatine kinase-MB (hazard ratio, 4.31; 99% confidence interval, 1.27-14.6; P=0.002). The cumulative mortality rate was 0.6% at 91 days.ConclusionsA significant association of postpercutaneous coronary intervention cardiac biomarker elevation with a small number of postpercutaneous coronary intervention outcomes was noted for the early (first 91 days) follow-up period with an identifiable optimal threshold of 25× ULN (0.25, ng/mL) for cTnT, which provided similar early outcome information as a cutoff of 5× ULN for creatine kinase-MB.© 2014 American Heart Association, Inc.

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