Biochemical detection of minor myocardial injury after elective, uncomplicated, successful percutaneous coronary intervention in patients with stable angina: clinical outcome.
BACKGROUND
Minor elevations of creatine kinase MB isoform (CK-MB) identified a population with a worse long-term prognosis after successful coronary intervention. Recent studies provide evidence that cardiac troponin I (cTnI) is more sensitive than CK-MB for the detection of minor myocardial injury after coronary intervention. The purpose of the study was to determine the prognostic value of cTnI elevation after elective uncomplicated successful percutaneous coronary intervention (PCI).


METHODS
cTnI was measured in 96 patients with stable angina before and 24 h after elective uncomplicated successful percutaneous transluminal coronary angioplasty (PTCA) with or without stenting. Patients were followed up for adverse cardiac events (recurrent angina, non-fatal myocardial infarction, cardiac death, repeat PCI or coronary bypass surgery). Procedure success was achieved in all cases.


RESULTS
Cardiac events were best predicted by cTnI when a cut-off value of 2.0 microg/L was used. Abnormal cTnI values at 24 h after PCI were observed in 26 patients (27%). Over a follow-up period of 24 months with no significant difference in the medication used, the incidence of recurrent angina, repeat PCI, coronary bypass surgery and cardiac death was 54%, 46%, 4% and 4%, respectively, in the cTnI-positive patients versus 27%, 16%, 4% and 0% in the cTnI-negative patients. Kaplan-Meier survival analysis showed that cTnI elevation was a significant correlate of cardiac events (P = 0.0198, by log rank analysis).


CONCLUSIONS
Elevation of cTnI is not uncommon after elective uncomplicated successful PCI in patients with stable angina and this elevation might be a marker of adverse long-term outcome.
Department of Pathology, Riyadh Armed Forces Hospital and Prince Sultan Cardiac Center, PO Box 7897-R715, Riyadh 11159, Saudi Arabia. mhabbabksa@sps.net.sa
Salam M
SM
Saadeddin
Moh'd A
MA
Habbab
Samia H
SH
Sobki
Gordon A
GA
Ferns
D000787:Angina Pectoris / Q000150:complications* / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D003402:Creatine Kinase / Q000032:analysis* / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D006335:Heart Injuries / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D007527:Isoenzymes / Q000032:analysis* / Q000097:blood; D008297:Male; D012016:Reference Values; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D019210:Troponin I / Q000032:analysis*
D015415:Biomarkers; D007527:Isoenzymes; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form