Segev Amit, Goldman Lorne E, Cantor Warren J, Barr Aiala, Strauss Bradley H, Winegard Luke D, Bowman Kim A, Chisholm Robert J
Division of Cardiology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Room 7-049, Toronto, Ontario, Canada M5B 1W8.
Cardiovasc Radiat Med. 2004 Apr-Jun;5(2):59-63. doi: 10.1016/j.carrad.2004.05.001.
Percutaneous coronary interventions (PCIs) are often complicated by postprocedural myocardial necrosis as manifested by elevated cardiac markers.
To assess the incidence and risk factors of elevated troponin-I (TnI) after PCI.
We performed a retrospective analysis on 522 PCI cases over a 1-year period at a single center. An elevated postprocedural TnI (>1.0 ng/ml) occurred in 213 patients (40.8%). Overall, glycoprotein (GP) IIb/IIIa inhibitors were used in 52% of cases. Baseline clinical characteristics were similar between the positive and the negative TnI groups. A univariate analysis revealed that patients with elevated TnI post-PCI had significantly more multivessel (28% vs. 15%, P = .001) and multilesion interventions (44% vs. 27%, P<.0001). The lesions were longer, more often angulated and involving bifurcations, and more complex in the TnI-positive group. Stent use and number of stents was higher in the TnI-positive group, and longer inflation times (>30 s) or higher inflation pressures (>14 atm) were used more often in the TnI-positive group. GP IIb/IIIa inhibitor use was higher in the TnI-positive group (61% vs. 45%, P = .0007). After multivariable analysis, independent predictors of elevated TnI after PCI included multilesion intervention, lesion length, lesion angulation, and GP IIb/IIIa inhibitor use.
TnI is elevated in approximately 40% of cases after PCI. TnI is more likely to be elevated after intervention on multiple lesions, angulated or long lesions.
经皮冠状动脉介入治疗（PCI）术后常并发心肌坏死，表现为心脏标志物升高。
评估PCI术后肌钙蛋白I（TnI）升高的发生率及危险因素。
我们对单中心1年内的522例PCI病例进行了回顾性分析。术后TnI升高（>1.0 ng/ml）的患者有213例（40.8%）。总体而言，52%的病例使用了糖蛋白（GP）IIb/IIIa抑制剂。TnI阳性组和阴性组的基线临床特征相似。单因素分析显示，PCI术后TnI升高的患者多支血管病变（28%对15%，P = 0.001）和多病变介入治疗的比例显著更高（44%对27%，P<0.0001）。TnI阳性组的病变更长，更常呈角状且累及分叉，病变更复杂。TnI阳性组的支架使用率和支架数量更高，且更常使用较长的球囊扩张时间（>30秒）或更高的球囊扩张压力（>14个大气压）。TnI阳性组的GP IIb/IIIa抑制剂使用率更高（61%对45%，P = 0.0007）。多变量分析后，PCI术后TnI升高的独立预测因素包括多病变介入治疗、病变长度、病变角度以及GP IIb/IIIa抑制剂的使用。
PCI术后约40%的病例TnI升高。对多个病变、角状或长病变进行干预后，TnI更有可能升高。
