Abstract
Objectives:
The aim of this meta‐analysis was to assess the prevalence and prognostic value regarding mortality of cTnT or cTnI elevations after nonemergent percutaneous coronary intervention (PCI) in a large number of cohort/registry studies.
Background:
Routine cardiac troponin measurement after elective PCI has been controversial among interventionalists. Recent studies have provided conflicting data in regard to predictive value of cardiac troponin‐T (cTnT) and troponin‐I (cTnI) elevation after non‐emergent PCI.
Methods:
Electronic and manual searches were conducted of all published studies reporting on the prognostic impact of cTnT or cTnI elevation after elective PCI. A meta‐analysis was performed with all‐cause mortality at follow‐up as the primary endpoint.
Results:
We identified 22 studies, involving 22,353 patients, published between 1998 and 2009. Postprocedural cTnT and cTnI were elevated in 25.9% and 34.3% of patients, respectively. Follow‐up period ranged from 3 to 67 months (mean: 17.7 ± 14.9 months). The results showed no heterogeneity among the trials (Q‐test: 25.39; I^2^: 17%; P = 0.23). No publication bias was detected (Egger's test: P = 0.16). The long‐term all‐cause mortality in patients with cTnI or cTnT elevation after PCI (5.8%) was significantly higher when compared to patients without cTnI or cTnT elevation (4.4%); OR 1.45 (95% CI: 1.22–1.72), P < 0.01. In addition, the postprocedural composite adverse clinical events of all‐cause mortality or myocardial infarction (MI) in patients with cTnI or cTnT elevation after PCI (9.2%) was significantly higher when compared to patients without cTnI or cTnT elevation (5.3%); OR 1.77 (95% CI: 1.48–2.11), P < 0.01.
Conclusions:
The current meta‐analysis indicates that cTnI or cTnT elevation after nonemergent PCI is indicative of an increase in long‐term all‐cause mortality as well as the composite adverse events of all‐cause mortality and MI. Efforts to routinely monitor periprocedural cTn levels along with more intensive outpatient monitoring/treatment of patients with cTn elevations may help to improve the long‐term adverse outcomes in these patients following non‐emergent PCI. © 2011 Wiley‐Liss, Inc.