title: Rise of serum troponin levels following uncomplicated elective percutaneous coronary interventions in patients without clinical and procedural signs suggestive of myocardial necrosis.
abstract: BACKGROUND
  The new definition of periprocedural myocardial infarction (type 4a MI) excludes patients without angina and electrocardiographic or echocardiographic changes suggestive of myocardial ischemia even though significant serum troponin elevations occur following percutaneous coronary intervention (PCI).
  
  
  OBJECTIVE
  To evaluate the incidence and predictors of serum troponin rise following elective PCI in patients without clinical and procedural signs suggestive of myocardial necrosis by using a high-sensitivite troponin assay (hsTnT).
  
  
  METHODS
  Three hundred and four patients (mean age: 60.8 ±8.8 years, 204 male) undergoing elective PCI were enrolled. Patients with periprocedural angina, electrocardiographic or echocardiographic signs indicating myocardial ischemia or a visible procedural complication such as dissection or side branch occlusion were excluded. Mild-moderate periprocedural myocardial injury (PMI) and severe PMI were defined as post-PCI (12 h later) elevation of serum hsTnT concentrations to the range of 14-70 ng/l and > 70 ng/l, respectively.
  
  
  RESULTS
  The median pre-procedural hsTnT level was 9.7 ng/l (interquartile range: 7.1-12.2 ng/l). Serum hsTnT concentration elevated (p < 0.001) to 19.4 ng/l (IQR: 12.0-38.8 ng/l) 12 h after PCI. Mild-moderate PMI and severe PMI were detected in 49.3% and 12.2% of patients, respectively. Post-procedural hsTnT levels were significantly higher in multivessel PCI, overlapping stenting, predilatation and postdilatation subgroups. In addition, post-procedural hsTnT levels were correlated (r = 0.340; p < 0.001) with the stent lengths.
  
  
  CONCLUSIONS
  High-sensitivite troponin measurements indicate a high incidence of PMI even though no clinical or procedural signs suggestive of myocardial ischemia exist. Multivessel PCI, overlapping stenting, predilatation, postdilatation and longer stent length are associated with PMI following elective PCI.
authors.affiliation: Department of Cardiology, School of Medicine, Acıbadem University, Istanbul, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Buturak
authors.affiliation: Department of Cardiology, School of Medicine, Acıbadem University, Istanbul, Turkey.
authors.forename: Aleks
authors.initials: A
authors.lastname: Degirmencioglu
authors.affiliation: Cardiology Department, Mehmet Akif Ersoy Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Surgit
authors.affiliation: Cardiology Department, Mehmet Akif Ersoy Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ali Rıza
authors.initials: AR
authors.lastname: Demir
authors.affiliation: Cardiology Department, Mehmet Akif Ersoy Education and Research Hospital, Istanbul, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Karakurt
authors.affiliation: Cardiology Department, Mehmet Akif Ersoy Education and Research Hospital, Istanbul, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Erturk
authors.affiliation: Cardiology Department, Siyami Ersek Education and Research Hospital, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Yazıcı
authors.affiliation: Medical Biochemistry Department, Faculty of Medicine, Acibadem University, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Serteser
authors.affiliation: Department of Cardiology, School of Medicine, Acıbadem University, Istanbul, Turkey.
authors.forename: Tugrul
authors.initials: T
authors.lastname: Norgaz
authors.affiliation: Department of Cardiology, School of Medicine, Acıbadem University, Istanbul, Turkey.
authors.forename: Sevket
authors.initials: S
authors.lastname: Gorgulu
keywords: coronary; injury; procedural