https://doi.org/10.1007/s00392-024-02526-y
1Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 2Division of Interventional Cardiology, Gottsegen Gyorgy National Cardiovascular Center Budapest, Ungarn; 3Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; 4Universitäts-Herzzentrum Freiburg - Bad Krozingen Innere Medizin III, Kardiologie und Angiologie Freiburg im Breisgau, Deutschland; 5MediClin Herzzentrum Lahr/Baden Innere Medizin und Kardiologie Lahr/Schwarzwald, Deutschland
Background:
Rotational atherectomy (RA) is a useful tool for preparation of calcified lesions during percutaneous coronary intervention (PCI). However, RA might increase procedure-related myocardial injury from embolizing fragmented debris into the microcirculation. Biomarkers of myocardial injury have been linked with adverse outcomes post-PCI. Yet, there is only limited data on cardiac Troponin T (cTnT) kinetics and the prognostic role after RA-assisted PCI. The aim of this study was to assess the kinetics of postprocedural cTnT and its association with all-cause mortality after RA-assisted PCI.
Methods and results:
Between January 2015 and December 2019, 597 consecutive patients who underwent RA-assisted PCI in a single high-volume tertiary Heart centre in Germany were included in our study. RA was performed at the operators' discretion for angiographically assessed heavily calcified lesions. Levels of cTnT were collected at baseline, and then 8-, 16- and 24 hours post PCI. The mean age of participants was 72.9 ± 9.1 years, 20.4% were women, 17% presented with acute coronary syndrome, 35% had diabetes, and 30% had a history of previous bypass surgery.
The primary endpoint of all-cause mortality occurred in 64 patients (10.7%) during a mean follow-up of 2.8 ± 1.1 years. Cox regression analysis showed a significant association between post-procedural cTnT levels and long-term all-cause Mortality (p< 0.001).
Using ROC analysis, an optimal cut-off for cTnT of >60x (upper reference limit) URL best correlated with all-cause long-term mortality with a c-statistic of 0.63, 95%CI [0.56-0.71]. Applying this threshold to the multivariate regression model for mortality prediction resulted in a hazard ratio of 2.42, 95%CI [1.40-4.20], p=0.001.
Conclusion
In this large contemporary cohort of patients who underwent RA-PCI, higher levels of postprocedural cTnT were significantly associated with long-term all-cause mortality with a cut-off value of > 60x URL. This supports the routine use of this biomarker measurement in post-procedural patient care.