42 Clinical impact of troponin and CK-MB release after percutaneous coronary intervention with rotational atherectomy; results from a prospective large registry

BackgroundAdjunctive techniques to modify calcium such as rotational atherectomy (RA) induce coronary artery trauma that may result in higher post-procedural troponin and creatinine kinase-MB (CK-MB) release. The clinical significance of these cardiac enzyme releases remains unclear. As such, we sought to examine the association of elevated cardiac enzymes with major adverse cardiac events (MACE).MethodsConsecutive patients undergoing PCI with RA for chronic coronary syndromes and unstable angina between 2012 and 2019 were included. Our practice is to routinely measure pre and post-PCI troponin & CK-MB. Patients with a positive pre-PCI CK-MB or troponin were excluded. Elevated post-PCI enzymes were categorised as multiples of the enzyme normal upper reference limit (URL); Troponin: 1x-5x, 5x-35, 35x-70x, >70x, and CK-MB: 1x-3x URL, 3x-5x URL, 5x-10x URL, >10x URL. MACE was defined as all-cause mortality or MI at 1-year follow-up.ResultsA total of 2,697 patients (mean age 70.0 ±10.4 years, 27% female, 48% diabetic, mean SYNTAX score 19.3±11.5) met the inclusion criteria. The majority of patients presented with stable angina (57.2%), 73.9% of cases had multivessel disease, and 29.0% of cases involved a bifurcation. Troponin and CK-MB levels in excess of the URL were detected in 22.2% and 18.2% of cases, respectively. Overall 6.8% (n=184), 1.8% (n=49) and 1.2% (n=33) of patients met the 4th Universal definition of myocardial infarction (UDMI), SCAI and ARC-2 definitions of periprocedural myocardial infarction, respectively. Across troponin and CK-MB categories, there was a significant association with MACE at 1-year. An association emerged with CK-MB and troponin levels >5x the URL for each enzyme. A peak troponin of 35x-70x the URL was independently associated with an increased risk MACE at 1-year follow up (adjusted hazard ratio [AHR] of 3.68, 95%CI [1.14–11.9], p=0.03), figure 1A. No category of CK-MB release post-PCI was independently associated with MACE at 1-year follow-up, figure 1B.Abstract 42 Figure 1a) All-cause death or MI at 1-year follow up based on post-PCI troponin. 1b) All-cause death or MI at 1-year follow up based on post-PCI CK-MB[Figure omitted. See PDF]ConclusionPost-procedural cardiac enzyme elevation occurred in 1 in 5 patients undergoing RA. Higher levels of post-PCI troponin and CK-MB were associated with an increased risk of MACE. Increased vigilance during follow-up may be justified for this subset of patients undergoing PCI.