Cardiovasc Revasc Med. 2026 Jun 3:S1553-8389(26)00237-X. doi: 10.1016/j.carrev.2026.05.013. Online ahead of print.
ABSTRACT
BACKGROUND: Post-procedural high-sensitivity cardiac troponin T (hs-TnT) is an established prognostic marker after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), yet its prognostic value may not be uniform across age groups, particularly when mortality and ischemic endpoints are considered separately.
METHODS: From a prospective PCI registry (March 2016-March 2019), 14,210 ACS patients were stratified by age (<65 vs ≥65 years) and post-procedural hs-TnT (<5× vs ≥5× upper reference limit). The primary endpoint was 12-month all-cause mortality; the secondary endpoint was ischemic events (cardiac death, myocardial infarction, or stroke). Age × hs-TnT interaction was assessed using multivariable Cox models and tensor product restricted cubic spline models.
RESULTS: At 12 months, 221 deaths and 312 ischemic events occurred. Elevated hs-TnT was associated with increased mortality in patients aged ≥65 (adjusted hazard ratio [aHR], 2.80; 95% CI, 1.84-4.27) but not in those aged <65 (aHR, 1.25; 95% CI, 0.75-2.07; P for interaction = 0.006). A concordant pattern was observed for cardiac death (P for interaction = 0.020). In contrast, elevated hs-TnT predicted ischemic events equally regardless of age (aged <65: aHR, 2.18; aged ≥65: aHR, 2.17; P for interaction = 0.995). Tensor product analysis confirmed a significant interaction for mortality (P = 0.048) but not for ischemic events (P = 0.935).
CONCLUSIONS: Age selectively modified the prognostic value of post-procedural hs-TnT for mortality, but not for ischemic events, in patients with ACS undergoing PCI. Age-stratified interpretation of post-procedural hs-TnT may improve post-PCI risk stratification if externally validated.
PMID:42248765 | DOI:10.1016/j.carrev.2026.05.013