Rise of serum troponin levels following uncomplicated elective percutaneous coronary interventions in patients without clinical and procedural signs suggestive of myocardial necrosis

The Asia-Pacific Society of Cardiology (APSC) Expert Committee Consensus Recommendations for Assessment of Suspected Acute Coronary Syndrome Using High-Sensitivity Cardiac Troponin T in the Emergency Department

The Asia-Pacific Society of Cardiology (APSC) high-sensitivity troponin T (hs-TnT) consensus recommendations and rapid algorithm were developed to provide guidance for healthcare professionals in the Asia-Pacific region on assessing patients with suspected acute coronary syndrome (ACS) using a hs-TnT assay. Experts from Asia-Pacific convened in 2 meetings to develop evidence-based consensus recommendations and an algorithm for appropriate use of the hs-TnT assay. The Expert Committee defined a cardiac troponin assay as a high-sensitivity assay if the total imprecision is ≤10% at the 99th percentile of the upper reference limit and measurable concentrations below the 99th percentile are attainable with an assay at a concentration value above the assay's limit of detection for at least 50% of healthy individuals. Recommendations for single-measurement rule-out/rule-in cutoff values, as well as for serial measurements, were also developed. The Expert Committee also adopted similar hs-TnT cutoff values for men and women, recommended serial hs-TnT measurements for special populations, and provided guidance on the use of point-of-care troponin T devices in individuals suspected of ACS. These recommendations should be used in conjunction with all available clinical evidence when making the diagnosis of ACS.

Gastrointestinal bleeding after emergency coronary intervention in elderly patients: Influencing factors and preventive measures

AIM

To analyze the factors influencing gastrointestinal hemorrhage (GIB) after percutaneous coronary intervention (PCI) in elderly patients and explore possible preventive measures.

METHODS

Fifty-six elderly patients who underwent emergency PCI at our hospital between July 2016 and May 2017 were included. Based on the occurrence of GIB or not, the patients were divided into an observation group and a control group. The patients in the observation group developed GIB in 6 months after PCI, and the control group did not. Univariate and multivariate analyses were performed to identify factors influencing GIB after emergency PCI.

RESULTS

Univariate analysis demonstrated that coronary artery triple vessel disease, right coronary artery disease, operative time, intraoperative use of heparin, ACEI/ARB drugs, and preventative proton pump inhibitors were significantly associated with GIB after emergency PCI (χ² = 7.286, 10.196, 3.420, 4.578, 6.475, 4.968, P < 0.05). Operative time, use of ACEI/ARB drugs, diuretics, and prophylactic proton pump inhibitors, coronary artery triple vessel disease, and intraoperative heparin were identified to be independent risk factors for GIB after emergency PCI (P < 0.05)

CONCLUSION

Operative time, use of ACEI/ARB drugs, diuretics, and prophylactic proton pump inhibitors, coronary artery triple vessel disease, and intraoperative heparin are independent risk factors for GIB after emergency PCI in elderly patients.

The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention

Introduction

Myocardial injury after percutaneous coronary intervention (PCI) occurs in approximately 30% of procedures, and is related to worse prognosis. Effects of remote ischemic preconditioning (RIPC) on reperfusion injury have been investigated before, yielding conflicting results.

Aim

To assess the impact of a single episode of RIPC on myocardial injury after elective PCI.

Material and methods

One hundred and four patients undergoing elective PCI, with normal baseline cardiac troponin-I (cTn-I) values, were randomized to two groups. Two patients were excluded due to data loss, and 102 patients were analyzed. Five minutes of ischemic preconditioning was delivered just before the intervention to the preconditioning group, by inflating the blood pressure cuff up to 200 mm Hg on the non-dominant arm. Postprocedural 16^th hour cTn-I, ΔcTn-I (difference between the 16^th h and baseline cTn-I values) and the prevalence of type 4a myocardial infarction were compared between the two groups.

Results

Median cTn-I values after the procedure were compared. 16^th hour cTn-I was insignificantly lower in the preconditioning arm (0.026 μg/l vs. 0.045 μg/l, p = 0.186). The incidence of cTn-I elevation 5-fold above the upper reference limit (URL) (> 0.115 μg/l) was lower in the preconditioning group, but it was also not significant (21.6% vs. 11.8%, p = 0.184).

Conclusions

A single episode of RIPC before elective PCI demonstrated less troponin elevation but failed to show a significant effect.