Higher incidence and serum levels of minor cardiac biomarker elevation in sirolimus-eluting stent (Cypher) than bare metal stent implantations.
OBJECTIVE
Minor cardiac biomarker elevation after percutaneous coronary intervention has long-term prognostic significance. The sirolimus-eluting stent (Cypher) has been reported to require high postinflation pressure for optimal implantation. We examined the incidence of minor cardiac biomarker elevation induced by Cypher implantation.


METHODS
We measured the serum concentration of cardiac troponin-I (cTnI) 24 h after stenting and those of creatine kinase isoenzyme MB and creatine kinase before, immediately after, and 6, 12 and 24 h after implantation in patients who underwent Cypher stent (CS group; n=53) or bare metal stent (BMS group; n=57) implantation.


RESULTS
No significant difference in clinical background was observed between the two groups. When a cutoff cTnI value of 0.50 ng/ml was used, the CS group showed a significantly higher incidence of cTnI elevation (35.8%, 19/53) than the BMS group (14.0%, 8/57) (P<0.05). Similarly, the incidence of cTnI > or = 0.03 ng/ml tended to be higher in the CS group (88.7%, 47/53) than in the BMS group (73.7%, 42/57: 0.05<P<0.10). Furthermore, the CS group showed significantly higher cTnI levels than the BMS group (1.32+/-2.38 vs. 0.34+/-0.91 ng/ml. P<0.001). Essentially, similar results were obtained for serum creatine kinase isoenzyme MB and creatine kinase. Among clinical, lesion and procedural characteristics, postinflation pressure for stenting was significantly higher only in the CS group (18.2+/-2.8 atm) than in the BMS group (14.0+/-2.7 atm) (P<0.001).


CONCLUSIONS
The results demonstrated that CS implantation increases the incidence of minor cardiac biomarker elevation compared with BMS. The difference in postinflation pressure could account for the results.
Seitou
Tetsushi
T
Department of Medicine and Medical Science, Okayama University Graduate School of Medicine, Sakakibara Hospital, Okayama, Japan.
Murakami
Masaaki
M
Komatsubara
Issei
I
Kawamura
Hiroshi
H
Yamamoto
Keizo
K
Hina
Kazuyoshi
K
Hirohata
Satoshi
S
Shinohata
Ryoko
R
Ninomiya
Yoshifumi
Y
Kusachi
Shozo
S
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002404:Catheterization / Q000009:adverse effects*; D015331:Cohort Studies; D052279:Creatine Kinase, MB Form / Q000097:blood*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000009:adverse effects*; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D007166:Immunosuppressive Agents; D019210:Troponin I; D052279:Creatine Kinase, MB Form; D020123:Sirolimus