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Correlation of Systemic Inflammatory Status and Cardiac Myonecrosis in Patients Undergoing Percutaneoues Coronary
1Dr Md Khaled Mohsin, Senior Consultant, &Associate Professor, Cardiology, National Heart Foundation Hospitals & RI, Mirpur, Dhaka, Bangladesh.
Insights
Pre-procedural high-sensitivity C-reactive protein (hs-CRP) levels do not predict cardiac myonecrosis after percutaneous coronary intervention (PCI). This study found no correlation between pre-PCI hs-CRP and post-PCI myocardial injury markers.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- High-sensitivity C-reactive protein (hs-CRP) is an inflammatory biomarker linked to cardiovascular events.
- Pre-procedural hs-CRP levels may influence outcomes following percutaneous coronary intervention (PCI).
- Previous studies suggest a link between pre-PCI CRP and PCI-induced cardiac myonecrosis.
Purpose of the Study:
- To investigate the influence of pre-PCI hs-CRP levels on post-PCI cardiac myonecrosis.
- To evaluate the role of procedural factors and medications in post-PCI myonecrosis.
Main Methods:
- Prospective observational study at a tertiary referral hospital.
- 38 patients with normal pre-procedural troponin T undergoing elective PCI were included.
- hs-CRP, troponin T (TnT), and CKMBM levels were measured before and after PCI.
Main Results:
- Elevated hs-CRP levels were common (>60%) before PCI and increased post-PCI (>65%).
- Significant increases in post-PCI TnT and CKMBM were observed (p<0.05).
- No significant correlation was found between pre-PCI hs-CRP and post-PCI TnT or CKMBM.
Conclusions:
- Pre-PCI hs-CRP levels did not correlate with post-PCI cardiac myonecrosis.
- Procedural parameters, age, and ongoing medications did not significantly influence cardiac myonecrosis.
- The study suggests pre-PCI hs-CRP is not a reliable predictor of myocardial injury post-PCI.
Abstract:
Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events. Pre-Percutaneoues coronary intervention (PCI) plasma hs-CRP concentration has been reported to influence both short and long term outcome after percutaneoues coronary intervention (PCI). Studies have reported association between pre-PCI CRP and PCI induced cardiac myonecrosis evaluated by sensitive marker of myocardial injury. The present study attempts to evaluate the influence of pre-PCI CRP levels, factors related to the procedure and ongoing medications on the event of post-PCI cardiac myonecrosis. This prospective observational study was done in a Tertiary referral hospital (St. James's Hospital, Dublin, Ireland) involving 38 patients with normal pre-procedural serum troponin T (<0.03μg/litre) undergoing elective PCI. Significantly high basal levels of hs-CRP was detectable in >60% patients undergoing elective PCI. This was further increased to >65% after PCI. Median value of hs-CRP before PCI was 3.61 (range 0.21-47.2mg/L). This value increased to 4.58 (range 0.44-39.2mg/L) after PCI (p<0.05). Though there was significant increase in the post-PCI median value (compared to the pre-PCI value) of TnT (0.015 vs. 0.01μg/L; p<0.001) and CKMBM (4.54 vs. 2.40μg/L; p<0.001), no significant correlation was found between pre-PCI hsCRP and post-PCI TnT (spearman correlation coefficient - 0.074; p=NS) as well as post-PCI CKMBM (spearman correlation coefficient - 0.036; p=NS). The changes in the values of TnT & CKMBM showed moderate positive correlation (spearman correlation coefficient - 0.52; p<0.001). Procedural parameters (of balloon dilatation and stent implantation) did not have significant correlation either. No significant influence of age and ongoing medications was found. Increased hs-CRP levels in serum before PCI was not correlated with significant cardiac myonecrosis detected after PCI.
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