Troponin response may vary
A striking finding in ALPHEUS was the discrepancy between very high rates of periprocedural troponin elevation and very low rates of clinical events through 30 days of follow-up. “When you look at these modest elevations of troponin it appears that there is a lot of noise here,” said Dr. Wiviott, vice president for clinical trials research and administration at Massachusetts General Hospital and Brigham and Women’s Hospital and a cardiologist at Harvard Medical School, Boston.
Troponin elevations in stable coronary patients undergoing PCI may have a different underlying mechanism than elevated troponins in patients undergoing PCI for an acute coronary syndrome, he added. In stable CAD patients, the phenomenon may be more related to atherosclerosis than to platelet activation and thrombosis.
During a panel discussion, Sunil V. Rao, MD, said cardiologists are “probably going to have to go back to the drawing board and think about what kinds of events are really, really important.”
American Heart Association
Dr. Sunil V. Rao
“It’s incumbent on our profession to figure out whether periprocedural MI should continue to be a component of the composite endpoint in PCI trials, because it’s highly dependent on the definition that’s being used,” observed Dr. Rao, professor of medicine at Duke University, Durham, N.C.
Dr. Silvain reported receiving institutional research funding and consulting fees from AstraZeneca, which funded the ALPHEUS trial. He serves as a consultant to a handful of other pharmaceutical companies as well.
Simultaneously with Dr. Silvain’s presentation at AHA 2020, the ALPHEUS results were published online in The Lancet.
SOURCE: Silvain J. AHA 2020. Session LBS 3.