A research team led by scientists from the University of Bologna has identified a new threshold for identifying patients most at risk of adverse events following coronary angioplasty. The study - published in the journal Circulation - shows that an increase of more than 40% in troponin levels, a protein found in heart muscle cells, is a risk signal that should be taken into account in patients who have undergone the procedure.
"This new threshold is a key indicator for identifying who is most at risk of adverse events," says Carmine Pizzi, Professor at the Department of Medical and Surgical Sciences at the University of Bologna, who coordinated the study. "This is a discovery that could improve risk stratification and clinical management, allowing clinicians to adopt more targeted and personalised strategies to reduce post-angioplasty complications and improve patient prognosis".
Coronary angioplasty is now a standard procedure for patients who have suffered an NSTEMI myocardial infarction, i.e. one that does not produce the typical electrocardiographic changes known as ST-segment elevation. The procedure is performed to restore blood flow to blocked arteries and reduce the risk of short- and long-term complications. However, adverse events can occur during the procedure that may affect a patient's prognosis.
One of the most insidious of these adverse events is periprocedural myocardial injury: a complication that can develop into a periprocedural myocardial infarction, leading to a significantly increased risk of future cardiac problems such as reinfarction, stroke or heart failure.
To study the characteristics and variables of this process, a research team led by scientists from the University of Bologna analysed data from more than 1,700 patients admitted to the Sant'Orsola General Hospital and the Ospedale Maggiore in Bologna.
"The results of our analysis show that about four in ten patients develop periprocedural myocardial injury after coronary angioplasty," says Professor Pizzi. "And among these, those who experience a periprocedural myocardial infarction have the highest risk of mortality and cardiovascular complications one year after the adverse event."
This is where troponin, a key biomarker of heart damage, comes into play. Until now, a post-angioplasty troponin increase of more than 20% has been considered a risk indicator for periprocedural myocardial infarction. However, this is a threshold value that has been established primarily on the basis of expert consensus, without solid scientific evidence.
The new analysis allowed the researchers to identify a more precise threshold of at least a 40% increase in troponin after the procedure.
"This new troponin threshold was found to be optimal for determining when periprocedural myocardial injury may put patients at risk of adverse events," says Professor Pizzi . "This provides physicians with a reliable tool to define personalised strategies and improve patient prognosis".
The study was published in the journal Circulation under the title "Prognostic Relevance of Type 4a Myocardial Infarction and Periprocedural Myocardial Injury in Patients with Non-ST-Segment-Elevation Myocardial Infarction". Participating on behalf of the University of Bologna were Matteo Armillotta, Luca Bergamaschi, Francesco Angeli, Angelo Sansonetti, Davide Bertolini, Francesca Bodega, Sara Amicone, Lisa Canton, Damiano Fedele, Nicole Suma, Andrea Impellizzeri, Francesco Pio Tattilo, Daniele Cavallo, Ornella Di Iuorio, Khrystyna Ryabenko, Francesco Saia, Paola Rucci, Alberto Foà and Carmine Pizzi.
