Prevalence and prognostic significance of preprocedural cardiac troponin elevation among patients with stable
Allen Jeremias1, Neal S Kleiman, Deborah Nassif
1Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
Circulation
|July 23, 2008
Summary
Pre-procedure cardiac troponin (cTn) elevation is common in stable coronary artery disease patients undergoing percutaneous coronary intervention (PCI). Elevated cTn independently predicts in-hospital and 1-year risk of death or myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Cardiac troponin (cTn) elevation is linked to periprocedural complications in acute coronary syndromes.
- The significance of preprocedural cTn elevation in stable coronary artery disease (CAD) patients undergoing PCI is not well understood.
Purpose of the Study:
- To determine the prevalence and prognostic value of preprocedural cTn elevation in patients with stable CAD undergoing PCI.
Main Methods:
- A prospective multicenter registry of 7592 patients undergoing PCI.
- Analysis focused on 2382 patients with stable CAD, examining preprocedural cTn levels and in-hospital/1-year outcomes.
Main Results:
- 6.0% of stable CAD patients had elevated preprocedural cTn.
- Elevated cTn was associated with higher rates of in-hospital death/myocardial infarction (13.4% vs 5.6%) and a trend for urgent repeat PCI.
- Baseline cTn elevation independently predicted composite of death/myocardial infarction at discharge (OR 2.1) and 1-year follow-up (OR 2.0).
Conclusions:
- Preprocedural cTn elevation is common in stable CAD patients undergoing PCI.
- It serves as an independent prognostic indicator for ischemic complications.
- Routine pre-PCI cTn testing may be warranted for this population.
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
Cardiac biomarkers are enzymes, proteins, and hormones released into the blood when cardiac cells are injured. They are powerful tools for triaging.
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:28Cardiac Catheterization I: Pre-Procedure Overview
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
01:27Coronary Artery Disease V: Interprofessional Care
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
01:30Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
01:30Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...