The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Peri-procedural Elevated Myocardial Biomarkers Predict Adverse Clinical Outcomes Following Elective Percutaneous Coronary Intervention: A Comprehensive Dose-Response Meta-Analysis of 24 Prospective Studies with 44972 patients

DOI: 10.4244/EIJ-D-19-00737

1. Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
2. Department of Cardiology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia, China
3. Norfolk and Norwich University Hospital, Norwich, UK
4. Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
5. Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University Singapore, Singapore; The Hatter Cardiovascular Institute, University College London, United Kingdom; Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan; Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico
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Abstract:Aims: The optimal cut-off value of isolated cardiac biomarker elevation for defining prognostically important percutaneous coronary intervention (PCI)-related myocardial injury is not known. We performed a meta-analysis to evaluate the dose-response relationship between isolated cardiac biomarker elevations and risk of all-cause mortality following elective PCI.

Methods and results: 24 prospective studies (44972 patients) were included. Patients with an isolated elevation of cardiac biomarkers, had increased risk of all-cause mortality when compared to those with no elevations (cardiac troponin I: odds ratio (OR) 1.42, 95% confidence interval (CI) 1.19-1.69; creatine kinase-MB isoenzyme (CK-MB) OR 1.43, 95% CI 1.19-1.70). For the dose-response analysis, elevations of cardiac troponin I >3x or CK-MB>1x99th percentile upper reference limit (URL) were associated with increased mortality (cardiac troponin I: OR 1.51 95% CI 1.05-2.17; CK-MB: OR 1.25, 95% CI 1.05-1.48). The pooled OR of mortality for each 3xURL increment of cardiac troponin I or CK-MB were 1.33 (95% CI 1.15-1.53) and 1.38 (95% CI 1.30 -1.47).

Conclusions: We found a positive dose-response relationship between isolated cardiac troponin I and CK-MB with all-cause mortality and elevated cardiac troponin I > 3x or CK-MB > 1x the 99th percentile URL was associated with the increased risk of mortality.

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