Clinical Evidence With Biomarker Confirmation for PPMI in PCI Clinical Trials Study (CEC-PPMI)

September 23, 2026 updated by: Baim Institute for Clinical Research

The goal of this prospective, multicenter, non-randomized observational study is to better identify and understand periprocedural myocardial injury among adults undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease or stabilized non-ST-elevation acute coronary syndrome. The main questions it aims to answer are:

  • Can a clinical criteria checklist identify patients with an increased likelihood of cardiac biomarker elevation following PCI?
  • Are positive clinical criteria and different post-PCI levels of troponin I, troponin T, and CK-MB associated with all-cause mortality or hospitalization for heart failure at one year? Researchers will compare participants with a positive clinical criteria checklist with those with a negative checklist to assess differences in post-PCI biomarker elevations and one-year clinical outcomes. Outcomes will also be compared between participants discharged on the same day and those hospitalized overnight.

Participants will:

  • Undergo PCI using commercially approved devices according to local standards of care.
  • Have blood samples collected before and after PCI to measure cardiac biomarkers.
  • Have relevant clinical and PCI procedural information collected, including completion of a clinical criteria checklist by the study team before discharge.
  • Be followed for one year to determine whether they have died from any cause or been hospitalized for heart failure.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Periprocedural myocardial infarction (PPMI) is commonly included as an outcome in clinical trials involving percutaneous coronary intervention (PCI). However, uncertainty remains regarding the most appropriate cardiac biomarker, biomarker threshold, and accompanying clinical criteria to use when defining PPMI. The increasing use of high-sensitivity troponin assays has further complicated the interpretation of cardiac biomarker elevations after PCI. Lower biomarker thresholds may identify a relatively large proportion of patients, but the clinical significance of these elevations and their relationship with subsequent adverse outcomes remain uncertain.

Several definitions of PPMI are currently used, including the Fourth Universal Definition of Myocardial Infarction, the Academic Research Consortium-2 (ARC-2) definition, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition. These definitions differ in their required biomarker thresholds and in how clinical evidence of periprocedural ischemia is incorporated. In addition, routine collection of serial post-PCI biomarkers can be challenging in contemporary practice, particularly because many patients are discharged on the same day as their procedure. Differences among cardiac biomarkers, including troponin I, troponin T, and creatine kinase-myocardial band (CK-MB), may also affect the frequency with which PPMI is diagnosed.

CEC-PPMI is a prospective, multicenter, non-randomized cohort study designed to evaluate the relationship among clinical evidence of periprocedural ischemia, cardiac biomarker elevation after PCI, and adverse clinical outcomes at one year. The study will enroll up to 1,000 adults at up to 20 clinical sites in the United States. An adaptive enrollment design will be used to ensure that at least 250 participants have positive clinical criteria.

Eligible participants will have stable coronary artery disease, including stable angina or functional evidence of ischemia, or stabilized non-ST-elevation acute coronary syndrome, and will be undergoing PCI. The PCI procedure will be performed according to local standards of care using commercially approved devices or devices being evaluated under an applicable investigational device exemption. The study does not assign a specific PCI device, treatment strategy, or medical therapy. The study will not analyze outcomes according to a specific device or manufacturer.

Before PCI, participants will provide informed consent. Baseline demographic information, clinical characteristics, and procedural and lesion-related information will also be collected.

All participants will have cardiac biomarker samples collected before PCI and approximately 4 to 6 hours after PCI. Participants who remain hospitalized will have an additional sample collected approximately 12 to 24 hours after PCI. All samples will be sent to and analyzed at a central laboratory for CK-MB, troponin T, and troponin I. Centralized analysis will allow direct comparison of these biomarkers using samples collected at the same time, with each participant serving as a matched control.

After PCI, the study team will complete a clinical criteria checklist. The checklist will identify clinical evidence potentially consistent with periprocedural myocardial ischemia, including relevant symptoms, electrocardiographic findings, and angiographic complications. The study team will also document whether the participant is planned for same-day discharge or hospitalization for at least one night.

Baseline lesion characteristics and PCI-related angiographic findings will be evaluated by an independent angiographic core laboratory. Assessments will include lesion length, bifurcation involvement, thrombus, percentage diameter stenosis, dissection, side-branch occlusion, distal embolization, and slow coronary flow. Agreement between clinical-site reporting and independent core-laboratory assessment of angiographic complications will be examined.

Participants will be categorized according to the result of the clinical criteria checklist and their planned post-PCI disposition. The four prespecified groups are:

  • Negative clinical criteria and same-day discharge.
  • Negative clinical criteria and hospitalization.
  • Positive clinical criteria and same-day discharge.
  • Positive clinical criteria and hospitalization. The primary endpoint is elevation of troponin I or troponin T to greater than five times the assay-specific upper reference limit following PCI, based on central laboratory measurements. The primary comparison will evaluate the frequency of this biomarker elevation among participants with positive clinical criteria compared with participants with negative clinical criteria.

The key secondary endpoint is the composite of all-cause mortality or hospitalization for heart failure at one year. This outcome will be compared between participants with positive and negative clinical criteria. The individual components of the composite endpoint will also be evaluated.

Additional analyses will examine:

  • The distribution and magnitude of troponin I and troponin T elevations after PCI.
  • The relationship between different biomarker thresholds and one-year all-cause mortality or hospitalization for heart failure.
  • Differences in biomarker elevations and clinical outcomes between participants planned for same-day discharge and those planned for hospitalization.
  • The frequency of PPMI according to the Fourth Universal Definition of Myocardial Infarction, ARC-2, and SCAI definitions.
  • Differences in the frequency of PPMI according to the biomarker used, including troponin I, troponin T, and CK-MB.
  • The effect of positive or negative clinical criteria on the relationship between post-PCI biomarker elevation and one-year clinical outcomes.
  • The association between elevated baseline biomarker levels and one-year all-cause mortality or hospitalization for heart failure.
  • The correlation among CK-MB, troponin T, and troponin I based on central laboratory measurements.
  • Agreement between clinical-site and angiographic core-laboratory reporting of PCI-related complications.
  • Whether participants with negative clinical criteria and planned same-day discharge represent a low-risk group with a reduced incidence of adverse clinical outcomes at one year.

Follow-up at one year to assess vital status and whether hospitalization for heart failure has occurred will be completed using a direct-to-participant remote approach. If contact with the participant is unsuccessful, an alternate contact will be approached. If this is also unsuccessful, a series of additional follow-up methods, as permitted by the participant's consent and applicable requirements, will be used to ascertain the secondary endpoint.

The study is intended to clarify whether a standardized, clinically driven assessment can help identify patients at increased risk for meaningful cardiac biomarker elevation after PCI and whether combining clinical criteria with specific biomarker thresholds improves the identification of patients at risk for adverse outcomes. The findings may also inform future definitions of PPMI and reduce the burden and missing data associated with routine serial biomarker collection in PCI clinical trials.

Study Type

Observational

Enrollment (Estimated)

1000

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Based on the results of the clinical criteria checklist and clinical team decision regarding same day discharge or planned hospitalization, there will be 4 study groups identified: Negative checklist/Same day discharge; Negative checklist/Hospitalization; Positive checklist/Same day discharge; Positive checklist/Hospitalization.

Description

Inclusion Criteria:

  1. Subject age is ≥ 18 years or minimum legal age as required by local regulations.
  2. Documented stable angina or functional testing demonstrating ischemia; or stabilized non-ST elevation acute coronary syndrome defined as negative or confirmed declining site determined biomarker.
  3. Subject is eligible for dual anti-platelet therapy treatment with aspirin plus either, clopidogrel, prasugrel, or ticagrelor.
  4. Life expectancy >1 year in opinion of investigator.
  5. Subject is willing and able to provide informed consent and comply with study procedures and required follow-up evaluations.

Exclusion Criteria:

  1. ST elevation myocardial infarction within 7 days
  2. Non-ST elevation myocardial infarction without stable or declining biomarkers.
  3. Previous percutaneous coronary intervention within 7 days.
  4. Inability to comply with recommended duration of dual anti-platelet therapy.
  5. Decompensated heart failure.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: COHORT
  • Time Perspectives: PROSPECTIVE

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Same day discharge with positive clinical checklist

Patients with a positive checklist and same day discharge
Diagnostic test: Biomarker testing

CKMB, Troponin T and Troponin I levels
Hospitalization with negative clinical checklist

Patients with a negative checklist and hospitalization
Diagnostic test: Biomarker testing

CKMB, Troponin T and Troponin I levels
Same day discharge with negative clinical checklist

Patients with a negative clinical checklist and same day discharge
Diagnostic test: Biomarker testing

CKMB, Troponin T and Troponin I levels
Hospitalization with positive clinical checklist

Patients with a positive clinical checklist and hospitalization
Diagnostic test: Biomarker testing

CKMB, Troponin T and Troponin I levels

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The rate of elevation of troponin I or T > 5 times the upper reference limit (URL)
Time Frame: Peri-procedural, up to 24 hours

The primary endpoint is the rate of elevation of troponin I or T > 5 times the upper reference limit (URL). The primary comparison will be for the group with positive clinical criteria checklist versus the group with negative clinical criteria checklist based on central laboratory assessment.
Peri-procedural, up to 24 hours

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
All-cause mortality at 1 year
Time Frame: 1 year

All-cause mortality at 1 year. The primary comparison will be for the group with positive clinical criteria checklist versus the group with negative clinical criteria checklist.
1 year

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Biomarker Analyses
Time Frame: Peri-procedural, up to 24 hours.
  • Distribution of CK-MB, troponin T and troponin I normalized as a ratio to the URL of each assay (mean ± SD, median, interquartile range).
  • Proportion of subjects with troponin T or I elevation > 5 times the URL in patients without hospitalization (same day discharge) compared with patients planned for hospitalization. Assess impact of second sample at 12-24 hours.
  • Frequency of troponin T versus troponin I elevations (<3 times URL; 3-5 times URL; >5-10 times URL; >10-35 times URL; >35-70 times URL; >70 times URL) overall and stratified by positive clinical criteria.
Peri-procedural, up to 24 hours.
One-Year Clinical Outcome Analyses
Time Frame: 1 year
  • Composite of all-cause mortality and heart failure hospitalization for positive clinical criteria versus negative clinical criteria. Unadjusted and adjusted for clinical and baseline lesion characteristics.
  • Mortality or heart failure hospitalization composite and components at 1 year for planned hospitalization versus same day discharge.
  • One year mortality or heart failure hospitalization composite and components by biomarker threshold (<3 times URL; 3-5 times URL; >5-10 times URL; >10-35 times URL; >35-70 times URL; >70 times URL) Troponin T, Troponin I, CKMB
1 year
Frequency of PPMI
Time Frame: Up to 24 hours

Frequency of PPMI according to various definitions.

  • 4th Universal (+ clinical criteria only) Troponin I or T, Troponin T, Troponin I
  • ARC II (>35 x URL for troponin with + clinical criteria or >5x ULN for CKMB with + clinical criteria) Troponin I or T, Troponin T, Troponin I, CKMB
  • SCAI Troponin I or T >70 times URL, Troponin T >70 times URL, Troponin I >70 times URL, CKMB >10 times URL
Up to 24 hours

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Baim Institute for Clinical Research

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

December 1, 2026

Primary Completion (Estimated)

December 1, 2028

Study Completion (Estimated)

December 1, 2029

Study Registration Dates

First Submitted

August 26, 2026

First Submitted That Met QC Criteria

September 23, 2026

First Posted (Actual)

September 30, 2026

Study Record Updates

Last Update Posted (Actual)

September 30, 2026

Last Update Submitted That Met QC Criteria

September 23, 2026

Last Verified

August 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CEC PPMI

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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