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Frequency and prognostic value of cardiac troponin I elevation after coronary stenting
Insights
Mild myocardial injuries, indicated by cardiac troponin I (cTnI) elevation after stenting, are common and linked to in-lab complications. However, isolated cTnI increase does not predict late adverse cardiac events.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Mild myocardial injury post-angioplasty correlates with adverse outcomes.
- The prognostic significance of cardiac troponin I (cTnI) elevation after stent implantation remains unclear.
Purpose of the Study:
- To investigate the incidence and prognostic value of cTnI and creatine kinase (CK) release after coronary stent implantation.
- To determine if marker elevation predicts in-hospital and late major adverse coronary events (MACE).
Main Methods:
- Prospective study of 109 patients undergoing stenting.
- Monitoring of postprocedural cTnI and CK levels.
- Assessment of in-hospital and late MACE over an 8-month follow-up.
Main Results:
- Postprocedural cTnI elevation occurred in 27% of patients, CK elevation in 15%.
- Marker elevation was associated with in-lab complications (p < 0.05).
- Isolated cTnI elevation did not predict late MACE, but concordant cTnI and CK elevation indicated higher risk for in-hospital MACE.
Conclusions:
- cTnI elevation is frequent after stenting and linked to procedural complications.
- Isolated cTnI elevation is not a reliable predictor of late MACE.
- Concordant cTnI and CK elevation suggests increased risk for in-hospital adverse events.
Abstract:
Mild myocardial injuries after coronary angioplasty are associated with adverse late outcomes. The incidence and prognostic value of this phenomenon when using cardiac troponin I (cTnI) after stent implantation is unknown. We studied cTnI and creatine kinase (CK) release in 109 patients after stenting. Clinical success was achieved in 103 patients (94%). In-hospital major adverse coronary events were: death in 1 patient, Q-wave myocardial infarction in 1 patient, and non-Q-wave myocardial infarction in 2 patients. Twenty-nine patients (27%) had postprocedural cTnI increase, 16 (15%) had CK elevation. No preprocedural variables predicted marker elevation. Marker release was related to the occurrence of in-lab complications (59% vs 29% [p = 0.004 for cTnI] and 69% vs 32% [p = 0.011 for CK]). In 34% no explanation was found for cTnI increase. Success was more frequent in patients without cTnI elevation (100% vs 86%, p <0.001). The negative predictive value of cTnI increase was 100% for in-hospital major adverse coronary events (MACE), whereas its positive predictive value was 14%. cTnI and CK concordant elevation was associated with more intra- and postprocedural adverse events. During a mean follow-up of 8+/-3 months, major adverse coronary events were: death in 2 patients, myocardial infarction in 2 patients, and repeat PTCA in 8 patients. cTnI elevation was not predictive of these late MACE. cTnI elevation is common after stenting, and is related to the occurrence of in-lab complications. Its isolated elevation is not a good predictor of MACE. Patients with concordant cTnI and CK elevation seem to be at higher risk of in-hospital MACE.