Comparison of different cardiac markers in monitoring percutaneous coronary interventions with frequent use of stents and gpIIbIIIa-antagonists.
Studies from the early 1990s found elevations of creatine kinase (CK) and its isoform CK-MB in 5-30% of patients after PCI, indicating minor myocardial damage. Less is known about the influence of modern improved PCI-techniques on the frequency of elevated cardiac markers and the correlation between different commonly used markers, especially cardiac troponins. From 1997 to 2001, 1486 patients undergoing PCI during the regular working hours were included in the prospective "Ludwigshafen Infarctlet Registry". Myocardial infarction in the past 48 hours was an exclusion criterion. Clinical and procedural data were documented. Follow-up data were obtained from discharge up to one year. PCI-related elevations of troponin T were found in 18%, of total-CK in 11%, of CK-MB in 33% and of myoglobin in 23% of cases. The correlation between the different markers was poor. Compared with troponin T, other markers showed low sensitivity (total-CK 58%, CK-MB 27%, myoglobin 22%) and, especially total-CK, low specificity. Stenting, side branch occlusion or major dissection, complex lesion morphology, gpIIbIIIa-antagonist application, proximal stenosis and unstable angina were independent predictors of an elevated troponin T in multivariate analysis. Due to this weak correlation between more specific and sensitive troponins and the other markers, troponins are preferred in monitoring after PCI. In addition to lesion characteristics, particularly stenting is associated with an increased rate of elevated troponin.
Mark
B
B
Herzzentrum Ludwigshafen, Kardiologie, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67073 Ludwigshafen, Germany. markb@klilu.de
Schneider
S
S
Schiele
R
R
Taubert
G
G
Kilkowski
C
C
Seidl
K
K
Nagel
D
D
Seiler
D
D
Senges
J
J
Zahn
R
R
D000368:Aged; D000789:Angina, Unstable / Q000201:enzymology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000201:enzymology; D009211:Myoglobin / Q000097:blood*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000201:enzymology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013223:Statistics as Topic; D015607:Stents; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D019210:Troponin I; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form