Relationship of Serum Cardiac Markers following Successful Percutaneous Coronary Intervention and Subsequent Exercise Capacity in Patients with Chronic Stable Angina: A Pilot Study

Abstract

We performed a pilot study to assess the significance of modest, asymptomatic, elevated serum cardiac markers – troponin T (TnT) and creatinine kinase-MB (CK-MB) – 18–24 h following successful elective percutaneous coronary intervention (PCI) and to explore their relationship with changes in aerobic exercise capacity, as measured by peak oxygen consumption (VO₂), 6 weeks following the procedure. Twenty-three patients with single-vessel disease and chronic angina performed an incremental cardiopulmonary exercise test before and 6 weeks after successful uncomplicated PCI. A venous blood sample was taken at rest before PCI and 18–24 h after the procedure. Successful PCI resulted in a trend towards an increased peak VO₂ [21.62 ± 0.64 (pre) vs. 23.03 ± 0.75 ml/ kg/min (post), p = 0.07; mean ± SEM]. There was a significant increase [median (IQR)] in TnT, from 0.00 (0.00) µg/l at baseline increasing to 0.02 (0.03) µg/l at 18–24 h, p = 0.002. CK-MB levels showed no significant difference. In the group of 15/23 (65%) patients with an elevation in serum TnT (≧0.01 µg/l), 18–24 h after successful PCI, there was no significant increase in peak VO₂ [23.31 ± 0.96 (pre) vs. 23.89 ± 1.09 ml/kg/min (post), p = 0.57]. In 8 (35%) patients with no rise in TnT at 18–24 h, a significant increase in peak VO₂ was observed following successful PCI [23.10 ± 0.91 (pre) vs. 25.09 ± 0.75 ml/kg/min (post), p = 0.02]. Although 7 of these 8 patients increased their peak VO₂, the absence of a TnT rise at 18–24 h was not significantly associated with an increase in peak VO₂ following successful PCI (p = 0.18). To confirm these interesting initial results and investigate the relationship of serum cardiac markers following successful PCI and subsequent exercise capacity, further studies are required.

Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial

“…The anatomic and haemodynamic effects of stenting on the coronaries are immediate, and symptomatic and exercise test improvements from unblinded PCI are well documented at 30 days,6 37 days,31 and 6 weeks. 32 As a result of the limited duration of ORBITA, it cannot address long-term myocardial infarction and mortality endpoints. Other trials such ISCHEMIA (NCT01471522) will do this.…”

Effect of Revascularization on Exercise-Induced Changes in Cardiac and Prothrombotic Biomarkers in Patients with Coronary Artery Disease

“…24 Somewhat in line with our results, Williams et al showed significant increase in resting TnT after revascularization in patients with stable angina pectoris, however, the blood samples were drawn only 18-24 hours after PCI. 25 Moreover, the exercise induced release of cTnT was found to be at the same magnitude 9 weeks after revascularization, which also can be discussed to be due to an ongoing disease development. Exercise induced release of cTnT in CAD patients has been shown in other studies, including our basis for the present investigation, 17 but somewhat dependent on the TnT assay used.…”

“… 24 Somewhat in line with our results, Williams et al showed significant increase in resting TnT after revascularization in patients with stable angina pectoris, however, the blood samples were drawn only 18-24 hours after PCI. 25 …”