Relation of minor cardiac troponin I elevation to late cardiac events after uncomplicated elective successful percutaneous transluminal coronary angioplasty for angina pectoris

Bertinchant, Jean-Pierre; Polge, Anne; Ledermann, Bertrand; Genet, L; Fabbro‐Peray, Pascale; Raczka, F.; Brunet, Jerome; Poirey, Sophie; Wittenberg, Olivier; Pernel, Isabelle; Nigond, J

doi:10.1016/s0002-9149(99)00191-5

Cited by 89 publications

(42 citation statements)

References 26 publications

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“…Our analysis of ACS patients treated with an early invasive strategy confirms that the relationship between TnI levels and outcome is maintained even in patients undergoing early revascularization [1,[21][22][23][24][25][26][27], in agreement with FRISC II and GUSTO IV trials [3,28]. However, in our population, TnI levels were not independently associated with mortality and cardiac ischemic events at long-term follow-up.…”

Section: Discussionsupporting

confidence: 88%

Early invasive strategy and outcomes of non-ST-elevation acute coronary syndrome patients: is time really the major determinant?

et al. 2011

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In non-ST-elevation acute coronary syndromes (ACS), an early invasive strategy is recommended for middle/high-risk patients; however, the optimal timing for coronary angiography is still debated. The aim of this study was to evaluate the prognostic implications of the time of angiography in ACS patients treated in accord with an early invasive strategy. We analyzed the relationship between the time of angiography and outcomes at followup in 517 ACS patients, of whom 482 were revascularized with percutaneous coronary intervention (PCI) (86.9%) or coronary artery by-pass graft (13.1%). We also evaluated the influence of clinical, biohumoral and angiographic variables on the patients' outcomes at follow-up. Among patients submitted to angiography at different time intervals from both hospital admission and symptom onset, significant differences neither in mortality nor in cardiac ischemic events at follow-up were observed. At univariate analysis, complete versus partial revascularization, longer hospital stay, higher TIMI risk score, diabetes mellitus, higher discharge creatinine and admission anemia were associated with mortality and cardiac ischemic events at follow-up; a lower left ventricular ejection fraction was associated with mortality; higher peak troponin I and previous PCI were associated with cardiac ischemic events at follow-up. At multivariate analysis longer hospital stay, higher discharge creatinine levels, and previous PCI were independent predictors of cardiac ischemic events at follow-up. Our evaluation in ACS patients treated with an early invasive strategy does not support the concept that angiography should be performed as soon as possible after symptom onset or hospital admission. Rather, an unfavorable long-term outcome is influenced principally by the clinical complexity of patients.

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Section: Discussionsupporting

confidence: 88%

Early invasive strategy and outcomes of non-ST-elevation acute coronary syndrome patients: is time really the major determinant?

et al. 2011

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“…On the other hand, the troponins I and T, considered a pattern for detecting myonecrosis, had a similar behavior, with 20 and 23% elevations in the second sample after stent implantation. Researchers have reported that the elevation of these 3 markers after intervention ranges from 20 to 40% [10][11][12] , usually exceeding the percentages of the cardiac enzymes, particularly the CK-MB activity, in concordance with our findings. We also observed that all 4 markers had increased more frequently in the second sample after the procedure.…”

Section: Incidence Of Intracardiac Thrombus and Thromboembolism In Thsupporting

confidence: 92%

“…In terms of laboratory repercussion, the worst finding of the 3 mentioned was occlusion of the side branches identified as the only variable independently associated with the elevation in all markers after stent implantation; however, its negative prognostic impact on the occurrence of major events was not confirmed on Cox regression. Since the initial investigations by Abdelmeguid et al 1,27 , later confirmed by other researchers 11,28 , the occlusion of secondary branches is one of the most frequent factors related to postintervention myonecrosis.…”

Section: Incidence Of Intracardiac Thrombus and Thromboembolism In Thmentioning

confidence: 89%

Avaliação comparativa do valor prognóstico de quatro marcadores bioquímicos de lesão miocárdica pós intervenções percutâneas utilizando stents coronarianos

Centemero¹,

Sousa²,

Staico³

et al. 2004

Arq. Bras. Cardiol.

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The systematic assessment of total creatine kinase (total CK) and its MB subfraction (CK-MB) after percutaneous coronary intervention shows that 5% to 40% of the patients successfully treated have an elevation in the serum level of those enzymes, which may represent a certain degree of myocardial necrosis [1][2][3] . Recently, the analysis of other very sensitive biochemical markers specific for identifying myocardial damage (CK-MB mass, troponins T and I) has intensified the detection of that phenomenon, which has been much more frequently observed with the implantation of coronary stents 4,5 .This study aimed at establishing the clinical meaning of those alterations and their impact on the occurrence of adverse cardiac events. It also had the following objectives: 1) to assess the incidence of the elevations in the CK-MB activity and mass and in the levels of troponins T and I after elective coronary stenting; 2) to analyze the association between the elevation of the markers and clinical, angiographic, and technical variables, and periprocedure problems; 3) to determine the prognostic effect of the elevation of the 4 markers after intervention on the occurrence of death, myocardial infarction, and need for new revascularization procedures in a one-year period. MethodsThis prospective study comprised 199 consecutive patients from the coronary angioplasty unit at the Instituto Dante Pazzanese de Cardiologia. They underwent elective coronary stent implantation for the treatment of stenoses located in native coronary arteries from August 2001 to January 2002. The patients met the following inclusion criteria: both genders; no restriction regarding age; normal levels of CK-MB activity in the 24 hours preceding the intervention; patients with clinically controlled stable or unstable angina (no recurrence of pain in the 2 weeks preceding the percutaneous treatment, to reduce the chances of an elevation in the troponins before the procedure); asymptomatic patients with ischemia detected on functional tests; presence of luminal obstruction > 50% in one or more vessels, with primary lesions anatomically favorable to stent implantation; absence of severe left ventricular dysfunction (EF > 0.30); elective treatment with angiographic success at the end of the procedure.The exclusion criteria were as follows: renal failure (creatinine > 2.0 mg/dL); presence of comorbidities that could affect late ResultsChanges in the levels of the 4 markers after stent implantation are relatively frequent (6.1% to 32.8%) ConclusionSystematic monitoring of CK-MB activity after coronary stenting is justified due to its clinical and laboratory behavior reported in studies relating its elevation after the procedure to a worse late outcome, and due to its low cost.

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“…The prevalence of periprocedural myocardial infarction is 7.3% to 17.9% defined by CK-MB isoenzyme elevation > 3x upper limit of normal (ULN) and 15.0% to 44.2% defined by cardiac troponin > ULN [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] . The results of several studies suggested that any elevation in CK-MB was associated with reduced long-term survival and that there was a direct correlation between the magnitude of myonecrosis and mortality.…”

Section: Mortality?mentioning

confidence: 99%

“…Other studies have shown that only large myocardial infarctions were predictive of a poor long-term outcome [40][41][42][43][44][45][46] . Similarly, some studies showed that the serum concentration of cardiac troponin was an independent predictor of survival, others did not [47][48][49][50][51][52][53][54][55] . However two recent meta-analyses concluded that an elevated cardiac troponin levels after PCI does provide prognostic information [56,57] .…”

Section: Mortality?mentioning

confidence: 99%

Myocardial ischemia is a key factor in the management of stable coronary artery disease

Iwasaki¹

2014

WJC

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Previous studies demonstrated that coronary revascularization, especially percutaneous coronary intervention (PCI), does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease. Many studies using myocardial perfusion imaging (MPI) showed that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit, whereas for patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality. There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia, which is associated with increased mortality. Studies using fractional flow reserve (FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI, and the presence of ischemia is the key to decisionmaking for PCI. Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method's limitations. Recent studies of appropriateness criteria showed that, although PCI in the acute setting and coronary bypass surgery are properly performed in most patients, PCI in the non-acute setting is often inappropriate, and stress testing to identify myocardial ischemia is performed in less than half of patients. Also, some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis. Taken together, the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease, and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Coronary artery bypass surgery; Coronary revascularization; Fractional flow reserve; Myocardial ischemia; Myocardial perfusion imaging; Percutaneous coronary intervention Core tip: Studies of myocardial perfusion imaging demonstrate that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit. For patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality probably because of worsened ischemia. Studies using fractional flow reserve demonstrate that ischemia-guided percutaneous coronary intervention (PCI) is superior to angiography-guided PCI, and the presence of ischemia is the key factor in decision-making for PCI. Thus, myocardial ischemia is a key factor in the management of patients with stable coronary artery disease.Iwasaki K. Myocardial ischemia is a key factor in the management of stable coronary artery disease. World J Cardiol

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Relation of minor cardiac troponin I elevation to late cardiac events after uncomplicated elective successful percutaneous transluminal coronary angioplasty for angina pectoris

Cited by 89 publications

References 26 publications

Early invasive strategy and outcomes of non-ST-elevation acute coronary syndrome patients: is time really the major determinant?

Early invasive strategy and outcomes of non-ST-elevation acute coronary syndrome patients: is time really the major determinant?

Avaliação comparativa do valor prognóstico de quatro marcadores bioquímicos de lesão miocárdica pós intervenções percutâneas utilizando stents coronarianos

Myocardial ischemia is a key factor in the management of stable coronary artery disease

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