Incidence and determinants of myocardial infarction following percutaneous coronary interventions according to the revised Joint Task Force definition of troponin T elevation

Int J Cardiol. 2010 Apr 1;140(1):66-72. doi: 10.1016/j.ijcard.2008.11.005. Epub 2009 Jan 7.


Background: Elevations in troponin T (TnT) occur frequently following percutaneous coronary intervention (PCI) and are associated with an adverse prognosis. The Joint ESC/ACC/AHA/WHF Task Force have released a proposal for a universal definition of myocardial infarction (MI), including diagnostic criteria for PCI associated MI. This is based on a TnT cut-point of more than three times the 99th percentile (0.03 ng/ml), which better reflects the precision of the assay. Our study investigated the incidence and predictive factors of a PCI associated MI, using the revised definition.

Methods: 325 patients were studied following PCI with stenting. TnT was collected at both 8 and 18 h following PCI in patients with either stable or unstable angina and normal baseline TnT levels. Comparison was made of both clinical and procedural characteristics of patients with and without a rise in TnT following intervention, using cut points of 0.01 and 0.03 ng/ml.

Results: TnT was elevated > or = 0.03 ng/ml in 27% and > or = 0.01 ng/ml in 39% of patients following PCI. Troponin elevation was significantly more likely in those patients who experienced peri-procedural ischemic symptoms or EKG changes, or in whom abciximab was used. The variables associated with a troponin rise showed a greater difference between TnT positive and negative patients when using 0.03 ng/ml compared to 0.01 ng/ml, suggesting that this may be a better definition of PCI-related MI.

Conclusions: Approximately one-quarter of low risk patients experience a procedural MI according to the revised definition. Rises in troponin were significantly associated with peri-procedural ischemic symptoms and EKG changes, and abciximab use, consistent with this level of TnT reflecting true myocardial necrosis.

MeSH terms

  • Abciximab
  • Aged
  • Angioplasty, Balloon, Coronary* / adverse effects
  • Antibodies, Monoclonal / therapeutic use
  • Electrocardiography
  • Humans
  • Immunoglobulin Fab Fragments / therapeutic use
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / epidemiology*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prognosis
  • Retrospective Studies
  • Troponin T / blood*


  • Antibodies, Monoclonal
  • Immunoglobulin Fab Fragments
  • Platelet Aggregation Inhibitors
  • Troponin T
  • Abciximab