Cardiac troponin elevation pattern in patients undergoing a primary percutaneous coronary intervention for ST-segment
Jonathan Buber1, Avishag Laish-Farkash, Nira Koren-Morag
1aDepartment of Cardiology, Leviev Heart Center, Sheba Medical Center, Tel Hashomer bCardiology Department, Barzilai Medical Center, Ashqelon cDepartment of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
The cardiac troponin elevation curve after primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) has a single peak. Later or higher troponin peaks indicate poorer reperfusion and predict adverse cardiovascular events.
Area of Science:
- Cardiology
- Biomarker kinetics
- Interventional cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
- Primary percutaneous coronary intervention (PPCI) is the standard treatment for STEMI.
- Cardiac troponin kinetics after PPCI can provide prognostic information.
Purpose of the Study:
- To describe the kinetics of cardiac troponin release after PPCI in STEMI patients.
- To evaluate the prognostic implications of the troponin release curve.
- To assess the relationship between troponin levels and reperfusion adequacy.
Main Methods:
- Prospective study of 175 consecutive STEMI patients undergoing PPCI.
- Serial measurements of cardiac troponin I levels.
- Collection of clinical, ECG, and echocardiographic data.
Main Results:
- The troponin elevation curve after PPCI was single peaked, with a median peak 715x the upper normal limit at 8 hours.
- Later or higher peak troponin levels correlated with poorer initial TIMI flow, less ST-elevation regression, lower blush scores, and distal embolization.
- Both higher peak troponin and later peaking were independently associated with increased risk of death, heart failure, and recurrent infarction.
Conclusions:
- The cardiac troponin elevation curve after PPCI in STEMI is single peaked and influenced by reperfusion success.
- Troponin curve kinetics serve as a simple surrogate marker for risk stratification in STEMI patients undergoing PPCI.
Hypothesis:
We aimed to describe the kinetics and associated prognostic implications of the cardiac troponin release curve after a primary percutaneous coronary intervention (PPCI) in patients presenting with ST-segment elevation myocardial infarction (STEMI).
Patients And Methods:
We prospectively determined, in a prespecified timely manner, serial cardiac troponin I levels and obtained clinical, ECG, and echocardiographic data from 175 consecutive patients hospitalized with STEMI who underwent PPCI. The median peak troponin levels and time until troponin peaking were determined.
Results:
The troponin elevation curve following PPCI was single peaked, with a median value measuring 715 times the upper normal limit and a median peaking time of 8 h. Later-peaking troponin levels were associated with a TIMI flow grade of 0/1 at the initiation of angiography and with lack of at least 70% regression in the ST-elevation on the first post-PPCI ECG. Higher peak values were similarly associated with these two parameters as well as with a lower blush score and with distal embolization during PPCI. Both higher peak values and later peaking of troponin were associated independently with higher occurrence of the combined adverse cardiovascular event outcomes consisting of death, congestive heart failure, and recurrent infarction.
Conclusion:
The cardiac troponin elevation curve following PPCI for STEMI shows a single peak and is affected by the adequacy of myocardial reperfusion. This method can serve as a simple surrogate for risk stratification of patients with STEMI who undergo PPCI.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
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...
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:27Myocarditis II: Clinical Features and Diagnostic Tests