Troponin I Elevation after Elective Percutaneous Coronary Interventions: Prevalence and Risk Factors
A Dev1, P K Das, B Bhattacharjee
1Dr Alock Dev, Resident, Department of Cardiology, Chattogram Medical College (CMC), Chattogram, Bangladesh;
Insights
Minor elevations in cardiac troponin I (cTnI) are common after percutaneous coronary intervention (PCI). This peri-procedural myocardial injury is associated with factors like older age, renal insufficiency, and multi-vessel stenting.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Percutaneous coronary intervention (PCI) is a primary treatment for coronary artery disease (CAD).
- Peri-procedural myocardial injury, even after successful PCI, can diminish its benefits.
- Understanding post-procedural cardiac troponin I (cTnI) elevation is crucial for optimizing PCI outcomes.
Purpose of the Study:
- To determine the prevalence of elevated cTnI after elective PCI.
- To identify risk factors associated with post-procedural cTnI elevation.
- To explore the relationship between cTnI levels and factors like age, BMI, smoking, diabetes, hypertension, dyslipidemia, family history, left ventricular dysfunction, renal insufficiency, and stent characteristics.
Main Methods:
- A hospital-based observational study involving 50 patients undergoing elective PCI.
- Serum cTnI levels measured before and 24 hours after PCI using FIA8000 analyzer.
- Statistical analysis, including univariate and multivariate analysis, to assess predictors of cTnI elevation (>1.0 ng/ml).
Main Results:
- Eighteen patients (36.0%) showed post-procedural cTnI elevation; 8 (16.0%) had significant elevation (>1.0 ng/ml).
- The change in cTnI from baseline to 24 hours was not statistically significant (p=0.057).
- Elevated cTnI was significantly associated with older age (>50 years), elevated pre-procedural serum creatinine, and multi-vessel stenting.
Conclusions:
- Minor cTnI elevation is a frequent occurrence following elective PCI.
- Risk factors for this elevation include advanced age, impaired renal function, and the extent of coronary stenting.
- Early identification and management of these risk factors may help mitigate cardiac tissue injury and cTnI elevation post-PCI.
Abstract:
Percutaneous coronary intervention (PCI) is one of the most important modalities of treatment for coronary artery disease (CAD). Minor extents of injury to the myocardium have been observed even after successful PCI. This peri-procedural injury might therefore reduce some of the beneficial effects of coronary revascularization. The objective of this hospital based comparative observational study was to determine the prevalence of post procedural Cardiac troponin I (cTnI) elevation after elective PCI and also to find out the relation with risk factors such as age, sex, body mass index (BMI), smoking, anemia, diabetes mellitus, hypertension, dyslipidemia, family history, left ventricular dysfunction, renal insufficiency, type of stent, number of stent and length of stent. This was a hospital based comparative observational study carried out in the Department of Cardiology, Chattogram Medical College Hospital (CMCH), Chattogram, Bangladesh from July 2018 to June 2019. A total of 50 patients who underwent elective PCI were included as sampled by purposive sampling method. Serum cTnI was measured by FIA8000 quantitative immunoassay analyzer with an analytical measurement before and at 24 hours of PCI. Value >1.0ng/ml was considered elevated. Univariate and multivariate analysis were applied to assess predictors for the occurrence of post-procedural elevation of cTnI. The mean±SD age of the study population was 54.96±9.1 years (range 35-74 years) and 34(68.0%) patients were male. Regarding cardiovascular risk factors, 17(34.0%) patients had diabetes mellitus, 27(54.0%) had dyslipidemia, 30(60.0%) had hypertension, 32(64.0%) were current or ex-smokers and 20(40.0%) had a family history of CAD. Eighteen patients (36.0%) had post-procedural cTnI elevation but only 8(16.0%) had significant (>1.0ng/ml) elevation. Change of cTnI before and at 24 hours of PCI was not significant (p=0.057). Cardiac Troponin I increase was related to age, pre-procedural serum creatinine and multi-vessel stenting. Minor elevation of cTnI was common following elective PCI and associated with few risk factors such as elderly patient (more than 50 years), raised serum creatinine and multi-vessel stenting. So, early detection of these risk factors, as well as effective intervention may help to prevent injury to cardiac tissue hence stop elevation of cardiac TnI following elective PCI.
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