title: Prognostic importance of troponin T and creatine kinase after elective angioplasty.
abstract: BACKGROUND
  The prognostic importance of elevated cardiac enzymes after elective percutaneous coronary intervention has been debated. Therefore, we performed a prospective observational study to evaluate the prognostic value of postprocedural rise of troponin T and creatine kinase.
  
  
  METHODS
  Troponin T (cut-off value 0.05 ng/ml) and creatine kinase (cut-off value 180 IU/l with muscle-brain fraction >4%) were measured 12 h after elective percutaneous coronary intervention in 713 consecutive patients without elevated troponin before the procedure. Primary endpoint was the combined incidence of death, myocardial infarction, stroke, repeat angiography or re-admission because of anginal symptoms during the follow-up period.
  
  
  RESULTS
  Troponin was elevated after the procedure in 150 patients (21%) and creatine kinase in 66 pts (9%), with a strong association between increased troponin and creatine kinase. After a mean follow-up of 10.9 months, mortality was low (1%) and not associated with increased troponin or creatine kinase. There was, however, a strong relation between postprocedural troponin and re-admission for angina (p=0.001) or myocardial infarction (p=0.001). Furthermore, troponin rise was significantly associated with an increased risk of the primary endpoint (relative risk 1.55 95% confidence interval 1.01-2.38). After multivariate analysis, troponin elevation but not increased creatine kinase was associated with an increased risk of the primary endpoint (relative risk 1.59 95% confidence interval 1.02-2.47 for troponin elevation versus 1.16 95% confidence interval 0.62-2.15 for increased creatine kinase).
  
  
  CONCLUSIONS
  Increase of troponin T after elective percutaneous coronary intervention has stronger prognostic implication when compared to increased creatine kinase.
authors.affiliation: Department of Cardiology, Isala klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Nienhuis
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: Bert
authors.initials: B
authors.lastname: Dikkeschei
authors.forename: Harry
authors.initials: H
authors.lastname: Suryapranata
authors.forename: Menko-Jan
authors.initials: MJ
authors.lastname: de Boer
authors.forename: Jan-Henk E
authors.initials: JH
authors.lastname: Dambrink
authors.forename: Jan C A
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: Marcel
authors.initials: M
authors.lastname: Gosselink
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D003402:Creatine Kinase / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D003402:Creatine Kinase