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Timing of peak troponin T and creatine kinase-MB elevations after percutaneous coronary intervention
Wayne L Miller1, Kirk N Garratt, Mary F Burritt
1Cardiovascular Division, Mayo Clinic and Foundation, Rochester, MN 55905, USA. miller.wayne@mayo.edu
Insights
Peak levels of cardiac biomarkers like troponin T (cTnT) and creatine kinase-MB (CK-MB) after percutaneous coronary intervention (PCI) occur later than typically monitored. This pilot study suggests longer surveillance intervals are needed for accurate prognostic assessment.
Area of Science:
- Cardiology
- Biomarker analysis
- Interventional cardiology
Background:
- Elevations in cardiac biomarkers creatine kinase-MB and troponin T (cTnT) are established prognostic indicators after percutaneous coronary intervention (PCI).
- Current clinical practice conventionally measures these biomarkers 6 to 8 hours post-PCI.
Purpose of the Study:
- To define the time to peak biomarker appearance in the circulation after PCI.
- To evaluate the adequacy of current surveillance monitoring times for prognostic assessment.
Main Methods:
- A nonrandomized, nonconsecutive cohort of 57 patients undergoing elective PCI.
- Measurements of cTnT and creatine kinase (CK)-MB were taken at baseline, 2, 4, 8 hours, and greater than or equal to 12 hours post-PCI.
Main Results:
- Post-PCI cTnT elevations occurred in 53% of patients, with 70% peaking at or after 12 hours.
- CK-MB elevations occurred in 25% of patients, with 79% peaking between 12 and 20 hours.
- Early surveillance (<12 hours) did not detect peak biomarker levels in most cases.
Conclusions:
- Both cTnT and CK-MB demonstrate a longer time to peak value than anticipated in clinical practice.
- Current early surveillance monitoring (<12 hours) is insufficient for detecting peak biomarker levels and may underestimate prognostic significance.
- Re-evaluation of post-PCI surveillance protocols to include longer time intervals is recommended to improve prognostic accuracy.
Study Objective:
The prognostic significance of elevations in creatine kinase-MB and troponin T (cTnT), which have been conventionally measured 6 to 8 h after percutaneous coronary intervention (PCI), has been established. However, the time to peak biomarker appearance in the circulation has not been defined and is the purpose of this pilot study.
Design:
Nonrandomized, nonconsecutive patient cohort.
Setting:
Clinical practice, Mayo Clinic, Rochester, MN.
Patients:
Cohort (n = 57) undergoing elective PCI.
Interventions:
cTnT and creatine kinase (CK)-MB measured at baseline, 2 h, 4 h, 8 h, and > or = 2 h (mean +/- SEM, 18 +/- 5 h) after PCI.
Measurements And Results:
Postprocedure cTnT elevations were detected in 30 of 57 patients (53%). Of these, 4 of 30 patients (13%) had peak cTnT at 4 h (0.80 +/- 0.40 ng/mL), 5 of 30 patients (17%) had peak cTnT at 8 h (1.07 +/- 0.48 ng/mL), and 21 of 30 patients (70%) had peak cTnT at > or = 12 h (0.21 +/- 0.06 ng/mL); 22 of 30 patients received abciximab. Elevations in CK-MB occurred in 14 of 57 patients (25%). Of these, 3 of 14 patients (21%) demonstrated peak CK-MB at 2 h (18.5 +/- 7.9 ng/mL) and the remainder (11 of 14 patients, 79%) during the 12- to 20-h interval (20.2 +/- 4.4 ng/mL); 12 of 14 patients received abciximab.
Conclusion:
More cTnT than CK-MB elevations occur after PCI; however, both biomarkers demonstrate a longer time to peak value than anticipated in clinical practice. Early surveillance monitoring (< 12 h) does not detect peak biomarker levels, especially in patients with normal baseline values. If peak levels are to be used to determine prognosis, then longer time intervals should be used for post-PCI surveillance. The timing of peak elevations appears to be influenced by baselines values as well. Early elevations may reflect the conjoint effects of injury associated with the disease process and the intervention itself. These data suggest that a re-evaluation of surveillance monitoring to account for the variability reported and the influence of baseline elevations of biomarkers may improve the prognostic power of the measurements.
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