Association of systemic inflammatory state with troponin I elevation after elective uncomplicated percutaneous coronary intervention

Saadeddin, Salam M.; Habbab, Moh’d A.; Sobki, Samia H.; Ferns, Gordon A.

doi:10.1016/s0002-9149(02)02253-1

Cited by 42 publications

(35 citation statements)

References 18 publications

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“…In this hypothesis, baseline C-reactive protein levels should be able to predict signifi cant troponin elevation post intervention. Contrary to Saadeddin et al, 19 we failed in this study to demonstrate this predictive ability of baseline infl ammation. In this previous report, which included a limited number of patients (n = 85), the authors used an arbitrary cutoff level of high-sensitivity C-reactive protein that was quite elevated (6 mg/l) to defi ne signifi cant enhanced infl ammation status.…”

Section: Discussioncontrasting

confidence: 99%

Baseline inflammation is not predictive of periprocedural troponin elevation after elective percutaneous coronary intervention

et al. 2009

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High-sensitivity C-reactive protein predicts future cardiovascular events in both healthy individuals and patients with unstable and stable coronary syndromes. Few data are available about the incidence and the relation to infl ammation of troponin elevation following percutaneous coronary intervention (PCI), a potential predictor of longterm outcome. We sought to confi rm the impact of embolization on long-term outcome and evaluate the ability of baseline infl ammation to predict troponin elevation induced by PCI. We prospectively analyzed 200 patients treated by PCI for stable or Braunwald IIA class unstable angina. The patients were recruited between January 1997 and May 1999, and the population was followed during a mean follow-up of 32 months. Major adverse cardiac events (MACEs) were defi ned as the occurrence of death, myocardial infarction or recurrent angina requiring repeat PCI, or coronary artery bypass grafting. During the follow-up period, 58 MACEs were observed. By multivariate analysis, independent predictors for the occurrence of MACEs were unstable angina and troponin I level after PCI (P < 0.0001 for both). No correlation was found between baseline infl ammation and signifi cant troponin I elevation post PCI and by multivariate analysis, no biological variable was a predictor of troponin I elevation post PCI. Baseline infl ammation cannot predict onset of minor myonecrosis damage (expressed by troponin elevation) induced by PCI, a significant predictor of long-term outcome in this setting.

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Section: Discussioncontrasting

confidence: 99%

Baseline inflammation is not predictive of periprocedural troponin elevation after elective percutaneous coronary intervention

et al. 2009

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“…15)16) Bonz et al 16) found the increase in the serum concentrations of both IL-6 and CRP to be more obvious in patients with concomitant post-procedural troponin T elevation. Saadeddin et al 17) reported preprocedural CRP elevation in 41% of 85 patients with stable angina and who undergoing PCI, and this was associated with a 2.27-fold higher risk of developing periprocedural myocardial injury, and the latter was defined by a postprocedural troponin I elevation of >2 ng/mL. Ellis et al 18) confirmed a nearly 4-fold higher preprocedural CRP level among the patients who developed postprocedural CK-MB elevation.…”

Section: Discussionmentioning

confidence: 97%

Changes of C-reactive Protein are Associated With Myocardial Injury After Successful Percutaneous Coronary Intervention

Rhee

Yun

et al. 2008

Korean Circ J

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Background and Objectives: Myocardial injury after percutaneous coronary intervention (PCI) occurs frequently and it is associated with an adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of inflammation has not yet been clearly determined. We evaluated the effect of an inflammatory response during PCI on periprocedural myocardial injury. Subjects and Methods: We prospectively studied 231 patients (mean age: 62.8±10.6 years, males: 60.6%) who underwent elective coronary stenting. For the exclusion of mechanical injury to the myocardium, we excluded those patients who developed complications during PCI. Blood samples for measuring the high sensitivity C-reactive protein (hsCRP) and troponin T (TnT) were obtained before the procedure and at 6 hours and 24 hours after PCI. The inflammatory response to PCI was calculated as the difference between the peak postprocedural hsCRP level and the preprocedural hsCRP level (delta CRP). We divided the patients according to the median value of delta CRP: Group I <2.2 mg/dL and Group II ≥2.2 mg/dL. Results: Postprocedural TnT elevation was were observed in 72 (31.2%) patients. The baseline clinical and angiographic characteristics were not difference between the two groups. The incidence of any TnT elevations was higher in the Group II than that in Group I (19.8% vs 42.6%, respectively, p<0.001). The incidences of TnT levels over 3 times the upper normal limit and 5 times the upper normal limit were also higher in Group II than in Group I (11.2% vs 21.7%, respectively, p=0.031, for a TnT level 3 times the upper normal limit, and 6.0% vs 13.9%, respectively, for a TnT level 5 times the upper normal limit). Multivariate analysis revealed that postprocedural hsCRP elevation and complex lesion were the significant independent predictors of postprocedural TnT elevation. Conclusion: Elevated hsCRP levels were associated with a higher risk of postprocedural troponin elevation in patients undergoing uncomplicated PCI. These results emphasized the role of inflammation in the pathogenesis of periprocedural myocardial injury.

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“…A previous study found that patients with high inflammatory parameters at baseline were more likely to develop increased troponin, indicative of myocardial cell damage. 7 Thus, patients presenting with a high level of inflammatory markers before PCI appear to be more prone to develop microembolizations. This could explain the prognostic importance of CRP at baseline, at least for short-and mid-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Prognostic Significance of High-Sensitivity C-Reactive Protein Before and After Coronary Angioplasty in Patients With Stable Angina Pectoris

Gach¹,

Legrand²,

Biessaux³

et al. 2007

The American Journal of Cardiology

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Abstract:We examined whether an increase in high-sensitivity C-reactive protein (hs-CRP) after percutaneous coronary intervention (PCI) predicts long-term prognosis in patients with stable angina pectoris. hs-CRP is an inflammatory marker that predicts future cardiovascular events in healthy subjects and patients with unstable and stable coronary syndromes. Long-term evaluation of pre-and postprocedural inflammatory markers has not been widely reported. In particular, the effect of the magnitude of increase in hs-CRP after PCI in stable patients is unknown. We prospectively analyzed 89 stable patients treated by PCI for stable angina pectoris. Patients were recruited between August 1998 and May 1999, and the population was followed until August 2005 (mean follow-up 79.5 ± 10.3 months). A major adverse cardiac event (MACE) was defined as the occurrence of cardiac death, myocardial infarction, or recurrent angina requiring repeat PCI or coronary artery bypass grafting. During the follow-up period, 36 patients presented with 1 MACE. In multivariate analysis, independent predictors of the occurrence of MACEs were previous myocardial infarction and a significant increase in hs-CRP after PCI (p = 0.004 and 0.003, respectively). A significant increase in hs-CRP after PCI was found to be more predictive of MACEs than hs-CRP before and after PCI. In conclusion, in stable coronary artery disease, inflammation is associated with long-term adverse events, but the magnitude of the inflammatory reaction after PCI appears more predictive than the baseline value.A previous study 1 has reported that high-sensitivity C-reactive protein (hs-CRP) increases after percutaneous coronary intervention (PCI) in patients with unstable angina pectoris and high baseline hs-CRP levels, but not in those with normal baseline hs-CRP. An increase in hs-CRP levels after PCI in this unstable condition does not seem to be related to the treated plaque but may rather be a marker of the inflammatory state. In stable coronary artery disease, it is unknown whether the magnitude of increase in hs-CRP after PCI provides independent prognostic information. The purposes of this study were to analyze the long-term prognostic importance of preand postprocedural hs-CRP and of the magnitude of hs-CRP increase in patients treated by elective PCI for stable angina pectoris. Methods and ResultsBetween August 1998 and May 1999, we prospectively analyzed 89 consecutive patients who were referred for coronary angiography for stable angina and exercise-induced ischemia. They underwent PCI of 1 coronary stenosis. Exclusion criteria were age 80 years, history of acute coronary syndrome with or without ST-segment elevation within the previous year, treatment for restenosis, coronary artery bypass grafting, or PCI within the previous 6 months, heart failure of New York Heart Association class 3, or known malignant or inflammatory disorders. Six-year follow-up was obtained in all patients by inspection of medical records. To ensure that no deaths were missed, the general ...

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Association of systemic inflammatory state with troponin I elevation after elective uncomplicated percutaneous coronary intervention

Cited by 42 publications

References 18 publications

Baseline inflammation is not predictive of periprocedural troponin elevation after elective percutaneous coronary intervention

Baseline inflammation is not predictive of periprocedural troponin elevation after elective percutaneous coronary intervention

Changes of C-reactive Protein are Associated With Myocardial Injury After Successful Percutaneous Coronary Intervention

Long-Term Prognostic Significance of High-Sensitivity C-Reactive Protein Before and After Coronary Angioplasty in Patients With Stable Angina Pectoris

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