Sensitivity and long‐term prognostic value of cardiac troponin‐i increase shortly after percutaneous transluminal coronary angioplasty

Abstract

SummaryBuckground: After successful coronary interventions, minor elevations of creatine kinase MB (CK-MB) identitied a population with a worse long-temi prognosis than that in patients without enzyme elevations. In that setting, cardiac troponin-I (cTn-I), a highly specific marker for myocardial injury, was considered for a small study; the results did not support the view that significant myocardial damage occurred during successful percutaneous transluminal coronary ang ioplasty (PTC A).Hypothesis: The present study was designed to assess the rate of elevated values ofcTn-I after successful PTCA and to determine its prognostic value.Merhods: CTn-I and CK-MB were measured in 44 patients before and daily for 3 days after PTCA. Two groups of patients were considered according to the presence or absence of elevated levels of cTn-I. The rate of free-event survival was estimated for the two groups using the Kaplan-Meier method and was compared with the log rank test.Rmdts: Globally, 36% of patients had an increase in cTn-I (normal values 0.35 ng/ml) and 9% had an increase in CK-MB. p = 0.002. The mean time to maximal enzyme level was 1.8 days for cTn-I and 2.2 days for CK-MB. Over a follow-up Conclusion: These results suggest that cTn-I is more sensitive than CK-MB in identifying minor myocardial damage after PTCA, but these elevated concentrations of cTn-I in the short-term aftermath of angioplasty do not seem to be a marker of worse long-term prognosis.

Influência do gênero no valor prognóstico da troponina I após angioplastia coronariana eletiva

“…Conversely, the prognostic value of elevations, even though minimal, of the cardiac necrosis biochemical markers for acute coronary syndromes (ACS) has been well demonstrated 11 . Previous studies have shown that elevated levels of the creatine kinase-MB (CK-MB) cardiac isoform after a PCI are relevant for prognosis purposes, but only when the levels are at least three times higher than the normal value 12,13 . The specificity and sensitivity of cardiac troponins (TnI and TnT) are considered to be higher than CK-MB [13][14][15] and are elevated in approximately 13 to 48% of the patients submitted to PCI 7,16,17 .…”

“…Previous studies have shown that elevated levels of the creatine kinase-MB (CK-MB) cardiac isoform after a PCI are relevant for prognosis purposes, but only when the levels are at least three times higher than the normal value 12,13 . The specificity and sensitivity of cardiac troponins (TnI and TnT) are considered to be higher than CK-MB [13][14][15] and are elevated in approximately 13 to 48% of the patients submitted to PCI 7,16,17 . The elevation or re-elevation of TnI after PCI in ACS is associated with a higher risk to develop cardiovascular events in the mid to long terms 5,10,18 .…”

Cardiospecific troponins in non-ischemic cardiological pathologies

“…In questi casi è preferibile utilizzare marcatori con cinetica più rapida, quali mioglobina e CK-MB. Inoltre, l'incremento delle troponine a seguito di procedure di rivascolarizzazione non sembra associato a una prognosi peggiore [68][69][70][71] , malgrado anche su questo aspetto non tutti i ricercatori siano concordi 72,73 . Anche altri tipi di interventi vascolari o cardiochirurgici, quali l'endoarterectomia carotidea o l'inserzione di protesi valvolari cardiache, possono essere accompagnati da incremento dei valori delle troponine 74,75 .…”

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

“…Serum cardiac troponins are more sensitive and specific markers than CK-MB for detection of minor myocardial damage following PCI [6, 7]. Previous work has demonstrated troponin to be elevated after unsuccessful procedures [7]and stenting [7, 8]when compared with percutaneous transluminal coronary angioplasty (PTCA) alone.…”

“…Two studies [6, 9]suggest that an elevation in serum troponin following elective successful PCI is not associated with an increased risk of a major adverse cardiac event (death, repeat revascularization or Q-wave myocardial infarction) up to 4 years following the procedure. However, Saadeddin et al [10]report an elevation in serum troponin to be a significant correlate of angina recurrence, cardiac death or repeat revascularization at 2-year follow-up.…”