Department of Cardiovascular Disease, Ochsner Health System, New Orleans, Louisiana 70121, USA.
Catheter Cardiovasc Interv. 2009 Nov 15;74(6):819-22. doi: 10.1002/ccd.22160.
To evaluate the clinical impact of microleaks of troponin, which are below the reference standard defining troponin elevation, on cardiovascular outcomes in stable coronary patients undergoing elective percutaneous coronary intervention (PCI).
Troponin elevation, either pre- or post-PCI, has been shown to predict poor cardiovascular outcomes. However, troponin measurements that are above the limit of detection but below the 99th percentile limit defining elevation ("microleak") have uncertain clinical significance.
We assessed subsequent myocardial infarction (MI) and death over a mean follow-up of 4.2 years in 2,272 patients undergoing elective PCI, where baseline troponins were normal and follow-up troponins were obtained 12-24 hr post-PCI. Patients were divided into three groups based on post-PCI troponin levels: Group 1 (n = 1,313) nondetectable; group 2 (n = 587) microleak, and group 3 (n = 372) elevated suggesting myocardial necrosis.
The combined endpoint of MI and death was similar in groups 2 and 3 (50.3 vs. 51.9%, respectively, P = NS), which was significantly more than group 1 patients (35.6%, P < 0.01) over the follow-up period. Multivariate analysis of patients in groups 1 and 2 demonstrated that troponin microleak was an independent predictor of MI and death (P = 0.01).
Microleak of troponin following elective PCI suggests myocardial injury and predicts an increased risk of subsequent MI and death. Troponins should be routinely assessed following PCI, and preventive therapies are needed to reduce micro and macro troponin elevation in the PCI setting.
评估肌钙蛋白微量渗漏（低于定义肌钙蛋白升高的参考标准）对行择期经皮冠状动脉介入治疗（PCI）的稳定型冠状动脉患者心血管结局的临床影响。
PCI 术前或术后肌钙蛋白升高已被证明可预测不良心血管结局。然而，检测限以上但低于定义升高的第 99 百分位限（“微量渗漏”）的肌钙蛋白测量值的临床意义尚不确定。
我们评估了 2272 例行择期 PCI 的患者在平均 4.2 年的随访中随后发生心肌梗死（MI）和死亡的情况，这些患者的基线肌钙蛋白正常，且在 PCI 后 12-24 小时获得了随访肌钙蛋白。根据 PCI 后肌钙蛋白水平将患者分为三组：第 1 组（n = 1313），检测不到；第 2 组（n = 587），微量渗漏；第 3 组（n = 372），升高提示心肌坏死。
第 2 组和第 3 组的 MI 和死亡联合终点相似（分别为 50.3%和 51.9%，P = NS），明显高于第 1 组患者（35.6%，P < 0.01）。对第 1 组和第 2 组患者的多变量分析表明，肌钙蛋白微量渗漏是 MI 和死亡的独立预测因素（P = 0.01）。
择期 PCI 后肌钙蛋白微量渗漏提示心肌损伤，并预测随后发生 MI 和死亡的风险增加。PCI 后应常规评估肌钙蛋白，需要预防治疗以减少 PCI 时的微和大肌钙蛋白升高。
