Postprocedural high-sensitivity troponin T and prognosis in patients with non-ST-segment elevation myocardial infarction treated with early percutaneous coronary intervention

Background: The association of postprocedural high-sensitivity troponin T (hs-TnT) with prognosis of non-ST-segment elevation myocardial infarction (NSTEMI) patients is incompletely investigated. Aim: To assess the prognostic value of hs-TnT in NSTEMI patients undergoing early percutaneous coronary intervention (PCI). Methods: This study included 3783 patients with NSTEMI undergoing early PCI. Preprocedural and peak postprocedural hs-TnT was measured. Patients were divided into 3 groups: a group with postprocedural hs-TnT in the 1st tertile (hs-TnT < 105 ng/L; n = 1264), a group with postprocedural hs-TnT in the 2nd tertile (hs-TnT ≥ 105 ng/L to 470 ng/L; n = 1258) and a group with postprocedural hs-TnT in the 3rd tertile (hs-TnT > 470 ng/L; n = 1261). The primary outcome was 1-year all-cause mortality. Results: Overall, there were 299 deaths: 59 (5.5%), 98 (8.2%) and 142 deaths (12.6%) among patients of the 1st, 2nd and 3rd postprocedural hs-TnT tertiles (unadjusted hazard ratio [HR] = 1.65, 95% confidence interval [CI] 1.20 to 2.67; P = 0.002 for tertile 2 vs tertile 1 and unadjusted HR = 2.41 [1.79–3.25]; P < 0.001 for tertile 3 vs tertile 1). After adjustment postprocedural hs-TnT was independently associated with the risk of all-cause mortality (adjusted [HR] = 1.22 [1.13–1.33], P < 0.001 for 1 unit higher log hs-TnT). Postprocedural hs-TnT improved the risk prediction of the model of all-cause mortality (the C statistic of the model without [with baseline variables only] and with incorporation of postprocedural hs-TnT was 0.759 [0.732–0.782] and 0.772 [0.746–0.794], respectively; P < 0.001). Conclusions: In patients with NSTEMI undergoing early PCI, postprocedural hs-TnT is independently associated with increased risk of mortality up to 1 year after PCI.