Varani Elisabetta, Balducelli Marco, Vecchi Giuseppe, Gatti Cinzia, Lucchi Giulia Ricci, Maresta Aleardo
Department of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy.
J Interv Cardiol. 2005 Aug;18(4):243-8. doi: 10.1111/j.1540-8183.2005.00042.x.
To compare the elevation of the three markers total creatine kinase (CK), CK-MB mass, and troponin I (TnI) and their relationship with clinical and procedural characteristics following percutaneous coronary intervention (PCI).
We prospectively evaluated 385 patients consecutively undergoing successful PCI. The three markers were systematically measured before and at 6, 12, and 24 hours after PCI. Any increase above the upper normal limit (UNL) of any marker has been considered abnormal when basal values were normal, while a further increase was needed when basal values were altered. Patients with ongoing acute myocardial infarction were excluded from the analysis.
TnI was above UNL in 183 patients (51%); in 138 (38.5%) it was the only marker altered. CK-MB mass was elevated in 12.8% patients, more than 3x UNL in 5.5% and more than 5x UNL in 2.8%. In over one half of these patients, CK-MB values peaked at 12 hours following PCI. Total CK was above UNL in 23 patients only (6.4%) and more than twice UNL in 5 (1.4%). Only 1 patient out of the 5 with CK-MB mass more than 10x UNL had total CK higher than twice UNL. In our population, post-PCI elevation of myocardial necrosis markers correlate with the occurrence of minor procedural complications (observed overall in 7.8% cases; TnI and/or CK-MB > 1xUNL 96% vs 47.5%, P < 0.001) and the presence of higher complexity clinical and/or procedural features, such as multivessel disease, multivessel or multilesion PCI, multiple stenting and use of glycoprotein IIb/IIIa inhibitors.
The elevation of at least one biochemical marker of myocardial necrosis is frequent following successful PCI with routine stent implantation. CK-MB mass is the most practical marker, having optimal kinetic and peaking with the first 12-18 hours post-PCI. Definitive data on the prognostic role and the applicability for the diagnosis of myocardial infarction of minor elevation of CK-MB mass or isolated increase of TnI are lacking.
比较经皮冠状动脉介入治疗（PCI）后总肌酸激酶（CK）、CK-MB质量和肌钙蛋白I（TnI）这三种标志物的升高情况及其与临床和手术特征的关系。
我们前瞻性评估了385例连续接受成功PCI的患者。在PCI前以及PCI后6、12和24小时系统测量这三种标志物。当基础值正常时，任何标志物高于正常上限（UNL）的升高都被视为异常；而当基础值改变时，则需要进一步升高才被视为异常。正在发生急性心肌梗死的患者被排除在分析之外。
183例患者（51%）的TnI高于UNL；其中138例（38.5%）是唯一改变的标志物。12.8%的患者CK-MB质量升高，5.5%的患者高于3倍UNL，2.8%的患者高于5倍UNL。在这些患者中，超过一半的患者CK-MB值在PCI后12小时达到峰值。仅23例患者（6.4%）的总CK高于UNL，5例患者（1.4%）高于两倍UNL。在CK-MB质量超过10倍UNL的5例患者中，只有1例患者的总CK高于两倍UNL。在我们的研究人群中，PCI后心肌坏死标志物的升高与轻微手术并发症的发生相关（总体观察到7.8%的病例；TnI和/或CK-MB>1倍UNL时为96%，而基础值正常时为47.5%，P<0.001），以及与更高复杂性的临床和/或手术特征的存在相关，如多支血管病变、多支血管或多处病变PCI、多个支架植入以及糖蛋白IIb/IIIa抑制剂的使用。
在常规支架植入的成功PCI后，至少一种心肌坏死生化标志物升高很常见。CK-MB质量是最实用的标志物，具有最佳的动力学特征，在PCI后最初12 - 18小时达到峰值。关于CK-MB质量轻微升高或TnI单独升高在心肌梗死诊断中的预后作用和适用性的确切数据尚缺乏。
