Differences in high-sensitivity troponin assay and association with myocardial injury and periprocedural MI after PCI for de novo three-vessel disease: insights from Multivessel TALENT

Abstract Background High-sensitivity cardiac troponin (hs-cTn) is recommended by current guidelines as the standard biomarker for diagnosing acute coronary syndrome. The measurement of hs-cTn has also become increasingly common for diagnosing periprocedural myocardial infarction (PPMI), along with creatine kinase-MB (CK-MB). However, hs-cTn may contribute to the overdiagnosis of periprocedural myocardial infarction after PCI. Purpose We investigated whether the type of high-sensitivity cardiac troponin (hs-cTn) assay influenced the diagnosis and incidence of PPMI in patients with de novo three-vessel disease in a randomized PCI trial (Multivessel TALENT). Methods The Multivessel TALENT trial is a randomised, 1:1, multicentre (54 centres in Europe), open-label study comparing clinical outcomes between the Supraflex Cruz™ and SYNERGY™ in patients with de novo 3VD without left main disease. PPMI was assessed according to three different definitions, SCAI, ARC-2, and the Fourth Universal Definition of MI (4th UDMI), based on post-PCI cardiac enzymes (hs-cTnI, hs-cTnT, CK-MB). Results 1548 patients underwent 2334 PCI procedures (1548 index and 786 staged). As post-procedural cardiac enzymes, both troponin and CK-MB were measured in 973 procedures (41.7%), troponin alone in 1061 (45.5%), CK-MB alone in 56 (2.4%), and neither in 244 (10.5%) (Figure A). Among the 2034 procedures with post-procedure troponin available, hs-cTnI was used in 848 (41.7%) and hs-cTnT in 1186 (58.3%). In patients with normal baseline troponin (N=996; Figure B1), hs-cTnI demonstrated higher rates of post-PCI elevations than hs-cTnT at 5×, 35×, and 70× the upper limit of normal (ULN) (all P0.001). In contrast, the rates above the CK-MB thresholds (5× and 10×ULN) were comparable between hs-cTnI and hs-cTnT groups (P=0.514 and 1.000). In those with elevated baseline troponin (N=857; Figure B2), the proportions with ΔcTn 5×, 35×, and 70×ULN were significantly higher with hs-cTnT than with hs-cTnI. ΔCK-MB 5×, 10×ULN were similar between groups (P=0.191 and P=0.461). According to the SCAI and ARC-2 definitions, the frequency of PPMI was significantly higher for hs-cTnI than for hs-cTnT (SCAI: 10.1% vs. 1.3%, P 0.001; ARC2: 5.4% vs. 2.2%, P 0.001) (Figure B3). Based on 4th UDMI, a similar trend toward higher frequency was observed with hs-cTnI (12.6% vs. 9.9%, P = 0.070). Conclusions In the post-PCI setting, hs-cTnI showed a more sensitive increase than hs-cTnT, and PPMI was more frequent when assessed using hs-cTnI. These findings suggest that the validity of using hs-cTn assays to define PPMI may need to be reconsidered.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.