Garbarz E, Iung B, Lefevre G, Makita Y, Farah B, Michaud P, Graine H, Vahanian A
Department of Cardiology, Tenon Hospital, Paris, France.
Am J Cardiol. 1999 Sep 1;84(5):515-8. doi: 10.1016/s0002-9149(99)00369-0.
Mild myocardial injuries after coronary angioplasty are associated with adverse late outcomes. The incidence and prognostic value of this phenomenon when using cardiac troponin I (cTnI) after stent implantation is unknown. We studied cTnI and creatine kinase (CK) release in 109 patients after stenting. Clinical success was achieved in 103 patients (94%). In-hospital major adverse coronary events were: death in 1 patient, Q-wave myocardial infarction in 1 patient, and non-Q-wave myocardial infarction in 2 patients. Twenty-nine patients (27%) had postprocedural cTnI increase, 16 (15%) had CK elevation. No preprocedural variables predicted marker elevation. Marker release was related to the occurrence of in-lab complications (59% vs 29% [p = 0.004 for cTnI] and 69% vs 32% [p = 0.011 for CK]). In 34% no explanation was found for cTnI increase. Success was more frequent in patients without cTnI elevation (100% vs 86%, p <0.001). The negative predictive value of cTnI increase was 100% for in-hospital major adverse coronary events (MACE), whereas its positive predictive value was 14%. cTnI and CK concordant elevation was associated with more intra- and postprocedural adverse events. During a mean follow-up of 8+/-3 months, major adverse coronary events were: death in 2 patients, myocardial infarction in 2 patients, and repeat PTCA in 8 patients. cTnI elevation was not predictive of these late MACE. cTnI elevation is common after stenting, and is related to the occurrence of in-lab complications. Its isolated elevation is not a good predictor of MACE. Patients with concordant cTnI and CK elevation seem to be at higher risk of in-hospital MACE.
冠状动脉血管成形术后的轻度心肌损伤与不良的晚期预后相关。支架植入后使用心肌肌钙蛋白I（cTnI）时这一现象的发生率及预后价值尚不清楚。我们研究了109例支架植入术后患者的cTnI和肌酸激酶（CK）释放情况。103例患者（94%）临床成功。院内主要不良冠状动脉事件包括：1例死亡、1例Q波心肌梗死和2例非Q波心肌梗死。29例患者（27%）术后cTnI升高，16例（15%）CK升高。术前无变量可预测标志物升高。标志物释放与实验室并发症的发生有关（cTnI：59% 对29% [p = 0.004]；CK：69% 对32% [p = 0.011]）。34% 的cTnI升高病例无合理解释。cTnI未升高的患者成功率更高（100% 对86%，p <0.001）。cTnI升高对院内主要不良冠状动脉事件（MACE）的阴性预测值为100%，而其阳性预测值为14%。cTnI和CK同时升高与更多术中及术后不良事件相关。在平均8±3个月的随访期间，主要不良冠状动脉事件包括：2例死亡、2例心肌梗死和8例重复经皮冠状动脉腔内血管成形术（PTCA）。cTnI升高不能预测这些晚期MACE。支架植入后cTnI升高很常见，且与实验室并发症的发生有关。其单独升高并非MACE的良好预测指标。cTnI和CK同时升高的患者院内发生MACE的风险似乎更高。
