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Mehta V, Sukhija R, Mehra P, Goyal A, Yusuf J, Mahajan B, Gupta VK, Tyagi S, Palaniswamy C, Aronow WS. Multimarker risk stratification approach and cardiovascular outcomes in patients with stable coronary artery disease undergoing elective percutaneous coronary intervention. Indian Heart J 2016; 68:57-62. [PMID: 26896268 PMCID: PMC4759483 DOI: 10.1016/j.ihj.2015.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022] Open
Abstract
Aims We studied the utility of multimarker risk stratification approach to predict cardiovascular outcomes in patients with stable coronary artery disease, undergoing elective percutaneous coronary intervention (PCI). Methods We prospectively evaluated 302 consecutive patients with stable coronary artery disease and normal CPK-MB and cardiac troponin T levels, and who underwent elective PCI at our institution. The following cardiac biomarkers were measured before and between 12 and 24 h post-procedure: CK-MB, cardiac troponin T, hs-CRP, and NT-ProBNP. Patients were followed up for a minimum of 6 months. Results Post-PCI, CPK-MB levels were elevated but below myocardial infarction (MI) range in 70 patients (23%), and in the MI range in 6 patients (2%). Troponin T levels were detectable but below the 99th percentile (microleak) in 32 patients (10.6%) and elevated above the 99th percentile (periprocedural MI) in 104 patients (34.4%). At 9 months’ follow-up, 1% died, 2% had stable angina, 10.3% had non-fatal MI, and 87.7% remained asymptomatic. There was no significant difference in clinical events among groups stratified by elevation of one biomarker or multiple biomarkers. Conclusion Single or multiple biomarker strategy in patients with normal baseline biomarkers failed to predict major cardiac events after PCI over medium-term follow-up.
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Affiliation(s)
- Vimal Mehta
- Department of Cardiology, G.B. Pant Hospital, Delhi, India
| | - Rishi Sukhija
- Department of Medicine, Division of Cardiology, IU Health La Porte Hospital, IN, United States
| | | | - Anuj Goyal
- Department of Cardiology, G.B. Pant Hospital, Delhi, India
| | - Jamal Yusuf
- Department of Cardiology, G.B. Pant Hospital, Delhi, India
| | - Bhawna Mahajan
- Department of Biochemistry, G.B. Pant Hospital, Delhi, India
| | - V K Gupta
- Department of Biochemistry, G.B. Pant Hospital, Delhi, India
| | - Sanjay Tyagi
- Department of Cardiology, G.B. Pant Hospital, Delhi, India
| | | | - Wilbert S Aronow
- Department of Medicine, Division of Cardiology, New York Medical College at Westchester Medical Center, Valhalla, NY, United States
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Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses. PLoS One 2013. [PMID: 23630624 DOI: 10.1371/journal.pone.0062080pone-d-13-00189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease is one of the major causes of death worldwide. Assessing the risk for cardiovascular disease is an important aspect in clinical decision making and setting a therapeutic strategy, and the use of serological biomarkers may improve this. Despite an overwhelming number of studies and meta-analyses on biomarkers and cardiovascular disease, there are no comprehensive studies comparing the relevance of each biomarker. We performed a systematic review of meta-analyses on levels of serological biomarkers for atherothrombosis to compare the relevance of the most commonly studied biomarkers. METHODS AND FINDINGS Medline and Embase were screened on search terms that were related to "arterial ischemic events" and "meta-analyses". The meta-analyses were sorted by patient groups without pre-existing cardiovascular disease, with cardiovascular disease and heterogeneous groups concerning general populations, groups with and without cardiovascular disease, or miscellaneous. These were subsequently sorted by end-point for cardiovascular disease or stroke and summarized in tables. We have identified 85 relevant full text articles, with 214 meta-analyses. Markers for primary cardiovascular events include, from high to low result: C-reactive protein, fibrinogen, cholesterol, apolipoprotein B, the apolipoprotein A/apolipoprotein B ratio, high density lipoprotein, and vitamin D. Markers for secondary cardiovascular events include, from high to low result: cardiac troponins I and T, C-reactive protein, serum creatinine, and cystatin C. For primary stroke, fibrinogen and serum uric acid are strong risk markers. Limitations reside in that there is no acknowledged search strategy for prognostic studies or meta-analyses. CONCLUSIONS For primary cardiovascular events, markers with strong predictive potential are mainly associated with lipids. For secondary cardiovascular events, markers are more associated with ischemia. Fibrinogen is a strong predictor for primary stroke.
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van Holten TC, Waanders LF, de Groot PG, Vissers J, Hoefer IE, Pasterkamp G, Prins MWJ, Roest M. Circulating biomarkers for predicting cardiovascular disease risk; a systematic review and comprehensive overview of meta-analyses. PLoS One 2013; 8:e62080. [PMID: 23630624 PMCID: PMC3632595 DOI: 10.1371/journal.pone.0062080] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 03/17/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiovascular disease is one of the major causes of death worldwide. Assessing the risk for cardiovascular disease is an important aspect in clinical decision making and setting a therapeutic strategy, and the use of serological biomarkers may improve this. Despite an overwhelming number of studies and meta-analyses on biomarkers and cardiovascular disease, there are no comprehensive studies comparing the relevance of each biomarker. We performed a systematic review of meta-analyses on levels of serological biomarkers for atherothrombosis to compare the relevance of the most commonly studied biomarkers. METHODS AND FINDINGS Medline and Embase were screened on search terms that were related to "arterial ischemic events" and "meta-analyses". The meta-analyses were sorted by patient groups without pre-existing cardiovascular disease, with cardiovascular disease and heterogeneous groups concerning general populations, groups with and without cardiovascular disease, or miscellaneous. These were subsequently sorted by end-point for cardiovascular disease or stroke and summarized in tables. We have identified 85 relevant full text articles, with 214 meta-analyses. Markers for primary cardiovascular events include, from high to low result: C-reactive protein, fibrinogen, cholesterol, apolipoprotein B, the apolipoprotein A/apolipoprotein B ratio, high density lipoprotein, and vitamin D. Markers for secondary cardiovascular events include, from high to low result: cardiac troponins I and T, C-reactive protein, serum creatinine, and cystatin C. For primary stroke, fibrinogen and serum uric acid are strong risk markers. Limitations reside in that there is no acknowledged search strategy for prognostic studies or meta-analyses. CONCLUSIONS For primary cardiovascular events, markers with strong predictive potential are mainly associated with lipids. For secondary cardiovascular events, markers are more associated with ischemia. Fibrinogen is a strong predictor for primary stroke.
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Affiliation(s)
- Thijs C van Holten
- Laboratory for Clinical Chemistry and Hematology, UMC Utrecht, Utrecht, The Netherlands.
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Uretsky BF. Should serum troponin after PCI be used to predict long-term outcomes?......Not quite yet! Catheter Cardiovasc Interv 2011; 77:1031-2. [PMID: 21598354 DOI: 10.1002/ccd.23209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Feldman DN, Kim L, Rene AG, Minutello RM, Bergman G, Wong SC. Prognostic value of cardiac troponin-I or troponin-T elevation following nonemergent percutaneous coronary intervention: a meta-analysis. Catheter Cardiovasc Interv 2011; 77:1020-30. [PMID: 21574239 DOI: 10.1002/ccd.22962] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 01/03/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this meta-analysis was to assess the prevalence and prognostic value regarding mortality of cTnT or cTnI elevations after nonemergent percutaneous coronary intervention (PCI) in a large number of cohort/registry studies. BACKGROUND Routine cardiac troponin measurement after elective PCI has been controversial among interventionalists. Recent studies have provided conflicting data in regard to predictive value of cardiac troponin-T (cTnT) and troponin-I (cTnI) elevation after non-emergent PCI. METHODS Electronic and manual searches were conducted of all published studies reporting on the prognostic impact of cTnT or cTnI elevation after elective PCI. A meta-analysis was performed with all-cause mortality at follow-up as the primary endpoint. RESULTS We identified 22 studies, involving 22,353 patients, published between 1998 and 2009. Postprocedural cTnT and cTnI were elevated in 25.9% and 34.3% of patients, respectively. Follow-up period ranged from 3 to 67 months (mean: 17.7 ± 14.9 months). The results showed no heterogeneity among the trials (Q-test: 25.39; I(2) : 17%; P = 0.23). No publication bias was detected (Egger's test: P = 0.16). The long-term all-cause mortality in patients with cTnI or cTnT elevation after PCI (5.8%) was significantly higher when compared to patients without cTnI or cTnT elevation (4.4%); OR 1.45 (95% CI: 1.22-1.72), P < 0.01. In addition, the postprocedural composite adverse clinical events of all-cause mortality or myocardial infarction (MI) in patients with cTnI or cTnT elevation after PCI (9.2%) was significantly higher when compared to patients without cTnI or cTnT elevation (5.3%); OR 1.77 (95% CI: 1.48-2.11), P < 0.01. CONCLUSIONS The current meta-analysis indicates that cTnI or cTnT elevation after nonemergent PCI is indicative of an increase in long-term all-cause mortality as well as the composite adverse events of all-cause mortality and MI. Efforts to routinely monitor periprocedural cTn levels along with more intensive outpatient monitoring/treatment of patients with cTn elevations may help to improve the long-term adverse outcomes in these patients following non-emergent PCI.
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Affiliation(s)
- Dmitriy N Feldman
- Greenberg Division of Cardiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10021, USA.
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Cay S, Cagirci G, Sen N, Balbay Y, Durmaz T, Aydogdu S. Prevention of Peri-procedural Myocardial Injury Using a Single High Loading Dose of Rosuvastatin. Cardiovasc Drugs Ther 2010; 24:41-7. [DOI: 10.1007/s10557-010-6224-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gómez-Hospital JA, Cequier A, Valero J, González-Costello J, Mañas P, Iràculis E, Teruel-Gila LM, Maristany J, Pascual M, Jara F, Esplugas E. Minor myocardial damage during percutaneous coronary intervention does not affect long-term prognosis. Rev Esp Cardiol 2009; 62:625-32. [PMID: 19480758 DOI: 10.1016/s1885-5857(09)72226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine whether long-term prognosis is affected by myocardial damage taking place during percutaneous coronary intervention (PCI). METHODS The study included consecutive patients undergoing PCI. Those with elevated baseline cardiac marker levels were excluded. Cardiac markers were evaluated and an ECG was recorded before and 12 and 24 hours after PCI. Patients were divided into three groups after PCI according to their cardiac marker levels: no myocardial damage (i.e. normal troponin and creatine kinase MB fraction [CK-MB]), minor damage (elevated troponin with normal CK-MB), and myonecrosis (elevated troponin and CK-MB). The occurrence of death, myocardial infarction or repeat revascularization during follow-up was recorded. RESULTS Minor myocardial damage associated with PCI was observed in 127 (16.8%) of the 757 patients included in the study and myonecrosis, in 46 (6.1%). During a follow-up of 45+/-14 months, cardiac events occurred in 151 (19.1%) patients. Mortality during follow-up was significantly higher in patients with myonecrosis (13%) than in the other two groups (4.8% and 3.9%; log rank, 6.83; P=.032). No difference was observed in the rate of myocardial infarction or repeat revascularization during follow-up. CONCLUSIONS Minor myocardial damage during PCI had no effect on long-term prognosis. In contrast, myonecrosis was associated with increased mortality. Consequently, the CK-MB level should be measured after all PCIs because of its prognostic implications, and strategies for reducing the risk of myonecrosis developing should be implemented.
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Affiliation(s)
- Joan A Gómez-Hospital
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, IDIBELL, Hospital Universitario de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.
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El daño miocárdico mínimo durante el intervencionismo coronario percutáneo no influye en el pronóstico a largo plazo. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71329-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Alcock RF, Roy P, Adorini K, Lau GT, Kritharides L, Lowe HC, Brieger DB, Freedman SB. Incidence and determinants of myocardial infarction following percutaneous coronary interventions according to the revised Joint Task Force definition of troponin T elevation. Int J Cardiol 2009; 140:66-72. [PMID: 19131135 DOI: 10.1016/j.ijcard.2008.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 09/12/2008] [Accepted: 11/01/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elevations in troponin T (TnT) occur frequently following percutaneous coronary intervention (PCI) and are associated with an adverse prognosis. The Joint ESC/ACC/AHA/WHF Task Force have released a proposal for a universal definition of myocardial infarction (MI), including diagnostic criteria for PCI associated MI. This is based on a TnT cut-point of more than three times the 99th percentile (0.03 ng/ml), which better reflects the precision of the assay. Our study investigated the incidence and predictive factors of a PCI associated MI, using the revised definition. METHODS 325 patients were studied following PCI with stenting. TnT was collected at both 8 and 18 h following PCI in patients with either stable or unstable angina and normal baseline TnT levels. Comparison was made of both clinical and procedural characteristics of patients with and without a rise in TnT following intervention, using cut points of 0.01 and 0.03 ng/ml. RESULTS TnT was elevated > or = 0.03 ng/ml in 27% and > or = 0.01 ng/ml in 39% of patients following PCI. Troponin elevation was significantly more likely in those patients who experienced peri-procedural ischemic symptoms or EKG changes, or in whom abciximab was used. The variables associated with a troponin rise showed a greater difference between TnT positive and negative patients when using 0.03 ng/ml compared to 0.01 ng/ml, suggesting that this may be a better definition of PCI-related MI. CONCLUSIONS Approximately one-quarter of low risk patients experience a procedural MI according to the revised definition. Rises in troponin were significantly associated with peri-procedural ischemic symptoms and EKG changes, and abciximab use, consistent with this level of TnT reflecting true myocardial necrosis.
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Al-Dakhiel Z, Larsen SR, Poulsen TS, Mickley H. Lack of consensus in biomarker measurement to diagnose PCI-related myocardial infarction. SCAND CARDIOVASC J 2008; 43:152-7. [PMID: 19003594 DOI: 10.1080/14017430802535063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate if biomarker sampling in PCI has adhered to the 2 000 consensus document for the diagnosis of procedure-related myocardial infarction (MI). DESIGN Firstly, a review of relevant papers from 2000 to September 2007 was done. Secondly, in October 2007, a questionnaire addressing biomarker sampling in routine PCI was sent to Danish PCI centres. RESULTS Fourteen papers fulfilled the selection criteria. In six studies serial sampling according to the consensus document had been done. Biomarker measuring before PCI was not performed in four studies. All centres answered the questionnaire. In none of six centres the proposed 3-sample testing of biomarkers had been followed. A pre-PCI sample was taken in one centre. In approximately half of the centres biomarkers were only measured on clinical indication. CONCLUSION Biomarker sampling for procedure-related MI according to the 2 000 consensus document has not been universally adapted. In order to avoid hampering of epidemiologic data and the comparison of future clinical trials it is proposed that the 2007 MI re-definition consensus document will be rapidly and universally accepted.
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Affiliation(s)
- Zaid Al-Dakhiel
- Department of Cardiology, Odense University Hospital, Denmark
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Uetani T, Amano T, Ando H, Yokoi K, Arai K, Kato M, Marui N, Nanki M, Matsubara T, Ishii H, Izawa H, Murohara T. The correlation between lipid volume in the target lesion, measured by integrated backscatter intravascular ultrasound, and post-procedural myocardial infarction in patients with elective stent implantation. Eur Heart J 2008; 29:1714-1720. [DOI: 10.1093/eurheartj/ehn248] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Nienhuis MB, Ottervanger JP, Bilo HJG, Dikkeschei BD, Zijlstra F. Prognostic value of troponin after elective percutaneous coronary intervention: A meta-analysis. Catheter Cardiovasc Interv 2008; 71:318-24. [PMID: 18288753 DOI: 10.1002/ccd.21345] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Although the prognostic importance of troponin in patients with anacute coronary syndrome is clear, the significance of troponin elevation after elective percutaneous coronary intervention (PCI) is a subject of debate. However, most studies up to now had a small sample size and insufficient events during follow-up. METHODS Electronic and manual searches were performed of studies reporting on prognosis of troponin after elective PCI. A meta-analysis was done of all suitable studies, with death in follow-up as primary endpoint and the combination of death or nonfatal myocardial infarction in follow-up as secondary endpoint. RESULTS 20 studies involving 15,581 patients were included. These studies were published between 1998 and 2007. Overall, troponin was elevated after elective PCI in 32.9% of patients. The follow-up period varied between 3 and 67 months (mean 16.3). Increased mortality was significantly associated with troponin elevation after PCI (4.4% vs. 3.3%, P = 0.001; OR 1.35). Furthermore, the combined endpoint of mortality or nonfatal myocardial infarction also occurred more often in patients with post-procedural troponin elevation (8.1% vs. 5.2%, P < 0.001; OR 1.59). CONCLUSIONS According to this meta-analysis, troponin elevation after elective PCI provides important prognostic information.
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Affiliation(s)
- Mark B Nienhuis
- Department of Cardiology, Isala klinieken, Zwolle, The Netherlands
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Jang SW, Seung KB, Park HJ, Park CS, Kim DB, Kim SH, Kim PJ, Jung HO, Baek SH, Choi KB. Elevated Troponin I after Implantation of Drug-Eluting Stents: Incidence, Predictors, and Prognostic Value. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.1.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sung-Won Jang
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hun-Jun Park
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chan-Suk Park
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong-Bin Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seong-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Pum Joon Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hae-Ok Jung
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Hong Baek
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyu-Bo Choi
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Nienhuis MB, Ottervanger JP, Dikkeschei B, Suryapranata H, de Boer MJ, Dambrink JHE, Hoorntje JCA, van 't Hof AWJ, Gosselink M, Zijlstra F. Prognostic importance of troponin T and creatine kinase after elective angioplasty. Int J Cardiol 2007; 120:242-7. [PMID: 17182137 DOI: 10.1016/j.ijcard.2006.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 10/05/2006] [Accepted: 10/14/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prognostic importance of elevated cardiac enzymes after elective percutaneous coronary intervention has been debated. Therefore, we performed a prospective observational study to evaluate the prognostic value of postprocedural rise of troponin T and creatine kinase. METHODS Troponin T (cut-off value 0.05 ng/ml) and creatine kinase (cut-off value 180 IU/l with muscle-brain fraction >4%) were measured 12 h after elective percutaneous coronary intervention in 713 consecutive patients without elevated troponin before the procedure. Primary endpoint was the combined incidence of death, myocardial infarction, stroke, repeat angiography or re-admission because of anginal symptoms during the follow-up period. RESULTS Troponin was elevated after the procedure in 150 patients (21%) and creatine kinase in 66 pts (9%), with a strong association between increased troponin and creatine kinase. After a mean follow-up of 10.9 months, mortality was low (1%) and not associated with increased troponin or creatine kinase. There was, however, a strong relation between postprocedural troponin and re-admission for angina (p=0.001) or myocardial infarction (p=0.001). Furthermore, troponin rise was significantly associated with an increased risk of the primary endpoint (relative risk 1.55 95% confidence interval 1.01-2.38). After multivariate analysis, troponin elevation but not increased creatine kinase was associated with an increased risk of the primary endpoint (relative risk 1.59 95% confidence interval 1.02-2.47 for troponin elevation versus 1.16 95% confidence interval 0.62-2.15 for increased creatine kinase). CONCLUSION Increase of troponin T after elective percutaneous coronary intervention has stronger prognostic implication when compared to increased creatine kinase.
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Affiliation(s)
- Mark B Nienhuis
- Department of Cardiology, Isala klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands
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Nienhuis M, Ottervanger J, Dambrink JH, Dikkeschei L, Suryapranata H, van ‘t Hof A, Hoorntje J, de Boer M, Gosselink A, Zijlstra F. Troponin T elevation and prognosis after multivessel compared with single-vessel elective percutaneous coronary intervention. Neth Heart J 2007; 15:178-83. [PMID: 17612680 PMCID: PMC1877967 DOI: 10.1007/bf03085977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND.: Although techniques for percutaneous coronary intervention (PCI) have improved, patients with PCI of more vessels may still have an increased risk. We performed a prospective observational study evaluating the differences between multivessel and single-vessel procedures according to postprocedural troponin T (TnT) elevation and events during follow-up. METHODS.: The study included 713 patients without elevated TnT (<0.05 ng/ml) before PCI. Primary endpoint was the combined endpoint of death, myocardial infarction, stroke, repeat coronary angiography and readmission for anginal symptoms during the mean follow-up of 10.9 months. RESULTS.: TnT after PCI was elevated in 150 patients (21%) and was significantly associated with an increased incidence of the primary endpoint (RR 1.55, 95% CI 1.01 to 2.38). PCI of more than one vessel was performed in 146 patients (20%). These patients more often had increased TnT levels after the procedure (31.5 vs. 18.3%, p=0.001) and an increased incidence of the primary endpoint during follow-up (28 vs. 19%, p=0.01). After multivariable analysis, multivessel PCI was a statistically significant predictor of postprocedural TnT increase (OR 1.90, 95% CI 1.17 to 3.06). Multivessel PCI was also associated with an increased risk of the primary endpoint (OR 1.73, 95% CI 1.18 to 2.52), but after adjusting for multivessel disease this association was not statistically significant (OR 1.42, 95% CI 0.92 to 2.19). CONCLUSION.: Elective PCI of more vessels in one session is, in comparison with single-vessel PCI, more often associated with postprocedural troponin T rise and a (nonsignificantly) higher incidence of cardiac events during follow-up. Whether staged PCI is associated with less morbidity has to be assessed. (Neth Heart J 2007;15:178-83.).
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Affiliation(s)
- M.B. Nienhuis
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - J.P. Ottervanger
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - J-H.E. Dambrink
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - L.D. Dikkeschei
- Department of Clinical Chemistry, Isala Clinics, Zwolle, the Netherlands
| | - H. Suryapranata
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | | | - J.C.A. Hoorntje
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - M.J. de Boer
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - A.T.M. Gosselink
- Department of Cardiology, Isala Clinics, Zwolle, the Netherlands
| | - F. Zijlstra
- Department of Cardiology, University Medical Centre Groningen, Groningen, the Netherlands
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Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, Wu AHB, Christenson RH. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Characteristics and Utilization of Biochemical Markers in Acute Coronary Syndromes. Circulation 2007; 115:e356-75. [PMID: 17384331 DOI: 10.1161/circulationaha.107.182882] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David A Morrow
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA
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Moore RKG, Lowe R, Grayson AD, Morris JL, Perry RA, Stables RH. A study comparing the incidence and predictors of creatine kinase MB and troponin T release after coronary angioplasty. Does Clopidogrel preloading reduce myocardial necrosis following elective percutaneous coronary intervention? Int J Cardiol 2007; 116:93-7. [PMID: 16870281 DOI: 10.1016/j.ijcard.2006.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 01/10/2006] [Accepted: 05/11/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate the incidence and associated factors for enzyme release following percutaneous coronary intervention comparing assessment with creatine kinase MB (CK-MB) and troponin T (TnT). METHOD TnT and CK-MB were measured post procedure in a consecutive series of 933 patients undergoing elective percutaneous coronary intervention between 1/4/2003 and 1/5/2004 at a single regional cardiac centre. RESULTS CK-MB level significantly correlated to TnT levels (R=0.747, p<0.001) and a CK-MB level of above 3 times the upper limit of the local reference range (>3 x ULN) was predicted with 95% sensitivity (48% specificity) at a TnT level of 0.11. Multivariate predictors of >3 x ULN CK-MB release for uncomplicated percutaneous coronary intervention (n=898) were multi-vessel angioplasty (OR=2.51, 95% CI=1.57 to 4.01; p<0.001), saphenous venous graft angioplasty (OR=5.5, 95% CI=1.94 to 13.00; p=0.005) and lack of Clopidogrel preloading (OR=2.02, 95% CI=1.30 to 4.38; p=0.027). CONCLUSIONS TnT was found to be a sensitive although not a highly specific marker of CK-MB release. In this study a TnT level above a threshold of 0.11 would identify 95% of the prognostically important 3-fold CK-MB releases. Replacing the >3 x ULN CK-MB threshold with a TnT level of 0.1 ng/l following percutaneous coronary intervention would increase the apparent rate of myocardial infarction from 11% to 20%. Lack of Clopidogrel preloading was independently associated with a >3 x ULN CK-MB release following uncomplicated elective percutaneous coronary intervention.
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Affiliation(s)
- Roger K G Moore
- The Cardiothoracic Center, Liverpool NHS Trust, Thomas Drive, Liverpool, L14 3PE, UK
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Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 2006; 47:e1-121. [PMID: 16386656 DOI: 10.1016/j.jacc.2005.12.001] [Citation(s) in RCA: 309] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 2006; 113:156-75. [PMID: 16391169 DOI: 10.1161/circulationaha.105.170815] [Citation(s) in RCA: 328] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
The new definition of acute myocardial infarction is based primarily on raised troponin levels because of the sensitivity and specificity of these markers and their correlation with the pathophysiology of acute coronary syndromes with plaque fissuring or rupture and embolisation of platelets causing myocyte necrosis. Raised troponin levels are associated with increased risks of death and recurrent myocardial infarction. Greater treatment benefit with low molecular weight heparin, IIb/IIIa antagonists and revascularisation is seen when troponin levels are raised. There are many implications for patients and society of the new definition including changes in insurability and ability to continue certain occupations. Many more patients, who would previously been diagnosed as having unstable angina, will now be diagnosed as having had an acute myocardial infarction. In addition case fatality rates will fall and comparison with previous epidemiological studies using the old definition will be problematic. However, the new definition may result in greater use of evidence based therapies with improved patient outcomes and decreased community death rates.
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Affiliation(s)
- C-K Wong
- Dunedin School of Medicine, Dunedin, New Zealand
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Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB, Morrison DA, O'neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention—Summary Article. J Am Coll Cardiol 2006; 47:216-35. [PMID: 16386696 DOI: 10.1016/j.jacc.2005.11.025] [Citation(s) in RCA: 254] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Panteghini M. The new definition of myocardial infarction and the impact of troponin determination on clinical practice. Int J Cardiol 2006; 106:298-306. [PMID: 15950298 DOI: 10.1016/j.ijcard.2005.01.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 01/13/2005] [Accepted: 01/19/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To discuss the more controversial clinical and laboratory aspects in the application of the new biochemical diagnostic standard for myocardial infarction, 4 years after its introduction, and to make some suggestions, which could allow for a more realistic application of the new definition in the current clinical practice. METHODS Studies published in the last 4 years in the most important cardiology and laboratory medicine journals (including proceedings of the international meetings), discussing advantages and limits of the new definition of myocardial infarction, were reviewed and pertinent data were discussed and compared with similar information available in literature. RESULTS AND CONCLUSIONS Although the exact status of implementation of the new definition of myocardial infarction cannot yet be known, the trend toward such recommendation is evolving significantly, even if at different rates in different countries. To make the transition smoother, major educational efforts are required to disseminate the conceptual reasoning behind the new guidelines. On the other hand, more knowledge is needed for some relevant issues, such as the different analytical performance of cardiac troponin assays or the prognostic significance of biomarker changes after a percutaneous coronary intervention.
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Affiliation(s)
- Mauro Panteghini
- Cattedra di Biochimica Clinica e Biologia Molecolare Clinica, Dipartimento di Scienze Cliniche Luigi Sacco, Facoltà di Medicina e Chirurgia--Polo di Vialba, Università degli Studi di Milano, Milano, Italy.
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Brasselet C, Garnotel R, Lafont A, Perotin S, Vitry F, Durand E, Ducher L, Elaerts J, Metz D, Gillery P. Prepercutaneous Coronary Intervention Plasma Homocysteine Concentration Is a Useful Predictor of Angioplasty-Induced Myocardial Damage. Clin Chem 2005; 51:2374-7. [PMID: 16306101 DOI: 10.1373/clinchem.2005.054072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
During the past three decades, percutaneous coronary intervention has become one of the cardinal treatment strategies for stenotic coronary artery disease. Technical advances, including the introduction of new devices such as stents, have expanded the interventional capabilities of balloon angioplasty. At the same time, there has been a decline in the rate of major adverse cardiac events, including Q-wave acute myocardial infarction, emergency coronary artery bypass grafting, and cardiac death. Despite these advances, the incidence of post-procedural cardiac marker elevation has not substantially decreased since the first serial assessment 20 years ago. As of now, these post-procedural cardiac marker elevations are considered to represent peri-procedural myocardial injury (PMI) with worse long-term outcome potential. Recent progress has been made for the identification of two main PMI patterns, one near the intervention site (proximal type, PMI type I) and one in the distal perfusion territory of the treated coronary artery (distal type, PMI type II) as well as for preventive strategies. Integrating these new developments into the wealth of clinical information on this topic, this review aims at giving a current perspective on the entity of PMI.
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Affiliation(s)
- Joerg Herrmann
- Department of Internal Medicine, Mayo Clinic Rochester, 200 First Street S.W., Rochester, MN 55905, USA.
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Silber S, Albertsson P, Avilés FF, Camici PG, Colombo A, Hamm C, Jørgensen E, Marco J, Nordrehaug JE, Ruzyllo W, Urban P, Stone GW, Wijns W. Guías de Práctica Clínica sobre intervencionismo coronario percutáneo. Rev Esp Cardiol 2005; 58:679-728. [PMID: 15970123 DOI: 10.1157/13076420] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J 2005; 26:804-47. [PMID: 15769784 DOI: 10.1093/eurheartj/ehi138] [Citation(s) in RCA: 855] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In patients with stable CAD, PCI can be considered a valuable initial mode of revascularization in all patients with objective large ischaemia in the presence of almost every lesion subset, with only one exception: chronic total occlusions that cannot be crossed. In early studies, there was a small survival advantage with CABG surgery compared with PCI without stenting. The addition of stents and newer adjunctive medications improved the outcome for PCI. The decision to recommend PCI or CABG surgery will be guided by technical improvements in cardiology or surgery, local expertise, and patients' preference. However, until proved otherwise, PCI should be used only with reservation in diabetics with multi-vessel disease and in patients with unprotected left main stenosis. The use of drug-eluting stents might change this situation. Patients presenting with NSTE-ACS (UA or NSTEMI) have to be stratified first for their risk of acute thrombotic complications. A clear benefit from early angiography (<48 h) and, when needed, PCI or CABG surgery has been reported only in the high-risk groups. Deferral of intervention does not improve outcome. Routine stenting is recommended on the basis of the predictability of the result and its immediate safety. In patients with STEMI, primary PCI should be the treatment of choice in patients presenting in a hospital with PCI facility and an experienced team. Patients with contra-indications to thrombolysis should be immediately transferred for primary PCI, because this might be their only chance for quickly opening the coronary artery. In cardiogenic shock, emergency PCI for complete revascularization may be life-saving and should be considered at an early stage. Compared with thrombolysis, randomized trials that transferred the patients for primary PCI to a 'heart attack centre' observed a better clinical outcome, despite transport times leading to a significantly longer delay between randomization and start of the treatment. The superiority of primary PCI over thrombolysis seems to be especially clinically relevant for the time interval between 3 and 12 h after onset of chest pain or other symptoms on the basis of its superior preservation of myocardium. Furthermore, with increasing time to presentation, major-adverse-cardiac-event rates increase after thrombolysis, but appear to remain relatively stable after primary PCI. Within the first 3 h after onset of chest pain or other symptoms, both reperfusion strategies seem equally effective in reducing infarct size and mortality. Therefore, thrombolysis is still a viable alternative to primary PCI, if it can be delivered within 3 h after onset of chest pain or other symptoms. Primary PCI compared with thrombolysis significantly reduced stroke. Overall, we prefer primary PCI over thrombolysis in the first 3 h of chest pain to prevent stroke, and in patients presenting 3-12 h after the onset of chest pain, to salvage myocardium and also to prevent stroke. At the moment, there is no evidence to recommend facilitated PCI. Rescue PCI is recommended, if thrombolysis failed within 45-60 min after starting the administration. After successful thrombolysis, the use of routine coronary angiography within 24 h and PCI, if applicable, is recommended even in asymptomatic patients without demonstrable ischaemia to improve patients' outcome. If a PCI centre is not available within 24 h, patients who have received successful thrombolysis with evidence of spontaneous or inducible ischaemia before discharge should be referred to coronary angiography and revascularized accordingly--independent of 'maximal' medical therapy.
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Smith SC, Feldman TE, Hirshfeld JW, Jacobs AK, Kern MJ, King SB, Morrison DA, O'Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention—summary article: A report of the American college of cardiology/American heart association task force on practice guidelines(ACC/AHA/SCAI writing committee to update the 2001 guidelines for percutaneous coronary intervention). Catheter Cardiovasc Interv 2005; 67:87-112. [PMID: 16355367 DOI: 10.1002/ccd.20606] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sidney C Smith
- American College of Cardiology Foundation, 9111 Old Georgetown Road, Bethesda, MD 20814-1699, USA
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Ramírez-Moreno A, Cardenal R, Pera C, Pagola C, Guzmán M, Vázquez E, Fajardo A, Lozano C, Solís J, Gassó M. Predictors and prognostic value of myocardial injury following stent implantation. Int J Cardiol 2004; 97:193-8. [PMID: 15458683 DOI: 10.1016/j.ijcard.2003.07.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2003] [Revised: 07/04/2003] [Accepted: 07/25/2003] [Indexed: 11/16/2022]
Abstract
BACKGROUND Troponin I concentrations are frequently elevated following percutaneous coronary intervention (PCI) even in procedures without complications and are considered, by some, as predictive of long-term morbidity and mortality. We assessed whether post-PCI troponin I concentrations bore any relationship to clinical, angiographic and in-laboratory minor adverse events indicative of myocardial injury and evaluated, in follow-up, whether these levels are useful as a predictive markers of adverse events. METHODS Patients (n=147) who were scheduled for PCI for stent placement were prospectively studied. In-laboratory events recorded were protracted chest pain, electrocardiographic changes, slow flows, dissections and lateral branch affectation. Troponin I and creatinine kinase MB fraction (CK-MB) mass were measured at baseline and post-procedure. Mean clinical follow-up was for 10.4+/-3.6 months. RESULTS During PCI, at least one adverse event occurred in 34% of patients and, in 38% of them, there was an elevation of troponin I as compared to 5.1% of those patients without any adverse event (relative risk=7.4; P<0.001). Elevation of troponin I concentrations occurred in 16.3% of all patients, 79.2% associated with an AE. CK-MB was elevated in 15.6% of patients. On multivariate analysis, protracted chest pain, lateral branch involvement and slow flow remained statistically significant in relation to post-procedure elevations of troponin I concentrations. Clinical follow-up showed a poorer prognosis in patients who had had elevated troponin I concentrations. CONCLUSIONS In-laboratory adverse event predict elevated post-procedure troponin I concentrations which are associated with myocardial injury. These elevations, in turn, predict poorer medium-term clinical outcomes.
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Affiliation(s)
- Antonio Ramírez-Moreno
- Servicio de Cardiología, Complejo Hospitalario Ciudad de Jaén, Avda Ejercito Español 10, 23007 Jaén, Spain.
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Kini AS, Lee P, Marmur JD, Agarwal A, Duffy ME, Kim MC, Sharma SK. Correlation of postpercutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortality. Am J Cardiol 2004; 93:18-23. [PMID: 14697460 DOI: 10.1016/j.amjcard.2003.09.006] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Creatine kinase-MB (CK-MB) and troponin I elevations after successful percutaneous coronary intervention (PCI) are common, and different gradations have been correlated with mortality. To establish which of these 2 markers of myonecrosis, CK-MB and troponin I, accurately predicts mortality after successful PCI, we analyzed 2,873 patients without acute myocardial infarction who underwent PCI for in-hospital events and mid-term mortality. Patients were stratified into 4 groups based on peak post-PCI cardiac markers values: group I: normal CK-MB (<16 U/L) or troponin I (<2 ng/ml); group II: CK-MB or troponin I levels 1 to 3 times normal; group III: >3 to 5 times normal; and group IV: >5 times normal. CK-MB elevation occurred in 16.1% of patients, with 12.2%, 2.3%, and 1.6% in groups II to IV, respectively. Troponin I elevation was detected in 38.9% of patients, with 16.4%, 8.4%, and 14.1% in groups II to IV, respectively. There was poor correlation between postprocedural CK-MB and troponin I values (r = 0.10) and in their individual subgroups. Kaplan-Meier estimates of death for postprocedure CK-MB were 2.1%, 2.7%, 1.7%, and 10.3% (p = 0.002) for groups I to IV, respectively; for troponin I, these estimates were 2.2%, 2.3%, 2.9%, and 2.1% for groups I to IV, respectively (p = 0.58). A Cox proportional hazards model showed that CK-MB >5 times normal was the strongest predictor of mortality (hazard ratio 6.7, 95% confidence interval 1.9 to 22.9; p = 0.002), although heart failure, peripheral vascular disease, pre-PCI digoxin therapy, and post-PCI renal failure also predicted mortality. However, neither troponin I peak elevation nor any subgroup predicted mortality. Troponin I is frequently elevated after PCI, but does not predict mortality. Periprocedural CK-MB elevation >5 times normal remains an independent predictor of mid-term mortality and a valuable marker for PCI prognosis in low-to-medium risk patients.
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Affiliation(s)
- Annapoorna S Kini
- Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029, USA
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Abstract
Care of the patient before and after percutaneous coronary interventions has changed largely because of the increased use of stents. Important patient management issues include the evaluation of chest pain after the procedure, recognition of acute vessel closure during the periprocedural period, management of the vascular access site, and prevention of contrast-induced renal dysfunction. Risk factor modification and drug therapies are important interventions for the secondary prevention of coronary events. Functional testing has a meaningful role in the evaluation of some patients after coronary intervention. It is important for the specialist in internal medicine to have a firm working knowledge of the various aspects of patient care before and after these procedures because their role in the management of these patients is increasing.
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Affiliation(s)
- Timothy A Mixon
- Department of Medicine, Scott & White Memorial Hospital and Clinic, Temple, Texas 76508, USA
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