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Troponin T elevation after successful directional atherectomy
E Giannitsis1, I von Lippa, M Müller Bardorff
1Medizinische Klinik II Medizinische Universität zu Lübeck Ratzeburger Allee 160 23538 Lübeck, Germany. giannits@medinf.mu-luebeck.de
Insights
Post-procedural cardiac troponin T (cTnT) elevation is common after directional atherectomy (DCA), linked to vascular complications and potentially microembolization. Higher cTnT levels may indicate increased restenosis risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarker Research
Background:
- The incidence and correlates of postinterventional cardiac troponin T (cTnT) elevation after successful directional atherectomy (DCA) remain unevaluated.
- Understanding these elevations is crucial for assessing procedural impact and patient outcomes.
Purpose of the Study:
- To evaluate the incidence and clinical correlates of postinterventional cTnT elevation in patients undergoing successful DCA.
- To compare the diagnostic performance of cTnT with CK-MB mass in identifying myocardial injury post-DCA.
Main Methods:
- Serial measurements of total creatine kinase (CK), CK-MB mass, and cTnT in 36 patients before and up to 72 hours after successful DCA.
- Clinical follow-up for 6 months for death, infarction, bypass surgery, vascular complications, and restenosis.
- Coronary angiography and intravascular ultrasound to assess vascular correlates pre- and post-DCA.
Main Results:
- Elevated cTnT occurred in 69.4% of patients, significantly more than CK-MB mass (36.1%).
- Post-DCA cTnT elevation was associated with vascular complications in 44% of cases, likely due to microembolization.
- A trend towards higher clinical restenosis rates (44% vs. 9%) was observed in patients with cTnT release post-DCA.
Conclusions:
- Successful DCA is linked to postprocedural cTnT elevations, correlating with minor vascular complications and microembolization.
- cTnT demonstrates superior diagnostic performance over CK-MB mass for detecting microinfarction.
- Further research is needed to confirm the association between cTnT elevation and the risk of restenosis and target vessel revascularization (TVR).
Background:
The incidence and correlates of postinterventional cardiac troponin T (cTnT) elevation have not been evaluated in patients with successful directional atherectomy (DCA).
Methods:
Total creatine kinase (CK) activity, CK-MB mass concentrations and cTnT levels were measured in 36 patients before, and serially 4, 24, 48 and 72 hours after successful DCA. Patients were followed for death, Q-wave infarction, need for emergency bypass surgery, periprocedural vascular complications (transient in-lab vessel closure, side branch compromise, large dissection), and non-Q-wave infarction on ECG. Patients were followed for clinical outcomes and angiographic restenosis for 6 months. Vascular correlates were studied by coronary angiography and intravascular ultrasound before, immediately after and 4 hours after elective and successful DCA.
Results:
25 patients (69.4%) had elevated levels of cTnT, whereas CK-MB mass > or = 6 ng/ml and mild elevations of total CK activity were present in only 36.1 and 5.6%, respectively. Elevated cTnT was related to vascular complications in 44% of cases. Inapparent microembolization of platelets or plaque debris was considered responsible for most of the remaining micronecroses. During 6 month follow-up rates of clinical restenosis (44 vs 9%, p = 0.059) tended to be higher in patients with as compared to patients without cTnT release after DCA.
Conclusion:
Successful DCA is associated with postprocedural elevations of cTnT which relate to minor vascular complications and presumably microembolization of platelets or plaque debris. The superior diagnostic performance of cTnT compared to CK-MB mass may relate to more sensitive identification of microinfarction. Further studies are mandatory to confirm the association between elevation of cTnT and risk of restenosis and TVR.