La Vecchia L, Bedogni F, Finocchi G, Mezzena G, Martini M, Sartori M, Castellani A, Soffiati G, Vincenzi M
Division Clinicizzata di Cardiologia, Vicenza, Italy.
Coron Artery Dis. 1996 Jul;7(7):535-40. doi: 10.1097/00019501-199607000-00008.
To assess whether and to what extent elective coronary stenting is associated with biochemical evidence of minor myocardial damage (MMD), as defined by the detection of abnormal post-procedural serum levels of one more among the following markers of ischaemic injury: creatine kinase (CK)-MB mass, troponin T (Tn-T) and troponin I (Tn-I).
Nineteen elective procedure of coronary stenting were compared with a matched group of 25 conventional percutaneous transluminal coronary angioplasty (PTCA) procedures performed in our laboratory from March to June 1995. Cases with evolving or recent (< 2 weeks) myocardial infarction, chronic total occlusions and dilation of saphenous vein grafts were excluded. By definition, all of the patients had undergone uneventful deployment of a single palmaz-Schatz stent, with no chest pain and no persistent ECG changes after the procedure. Serum levels of CK-MB mass, Tn-T and Tn-I were determined at baseline and 6, 12 and 24 h after the procedure. The frequency of abnormal results was determined for each marker. Baseline and peak post-procedural levels in the two groups were compared and related to procedural variables.
Baseline values were normal in all cases. The quantitative analysis showed that post-procedural levels of each marker (including total CK) were significantly higher with respect to baseline in both groups. In the stent group, two patients had positive CK-MB mass, four positive Tn-T and seven positive Tn-I. Absolute changes in Tn-T and Tn-I were closely related to changes in CK-MB mass (r = 0.76, P < 0.0001; r = 0.90, P < 0.0001), respectively). Three of these patients developed clinically silent side-branch occlusion. All of them were positive for troponins and two were positive for CK-MB. No correlation was found between procedural variables and the results of biochemical assays. In the PTCA group, three patients were positive for Tn-I, whereas the CK-MB mass and Tn-T remained constantly normal. No side-branch occlusion was observed. The peak CK-MB mass and Tn-I were significantly higher in the stent group than they were in the PTCA group (3.04 +/- 4.1 versus 1.27 +/- 1.3 ng/ml, P = 0.046; 0.78 +/- 1.17 versus 0.28 +/- 0.3 ng/ml, P = 0.046, respectively). This difference was no longer apparent when patients with side-branch occlusion were excluded.
In our series, Tn-I measurement shows the highest ability to detect MMD, being positive in 37% of stent and 14% of PTCA cases. Elective coronary stenting associated with greater release of CK-MB mass and Tn-I than is conventional PTCA. This finding is mainly determined by cases of side branch occlusion, which account for most, but not all, periprocedural MMD in the stent group.
评估选择性冠状动脉支架置入术是否以及在何种程度上与轻微心肌损伤（MMD）的生化证据相关，MMD定义为术后检测到以下缺血性损伤标志物中一种或多种的血清水平异常：肌酸激酶（CK）-MB质量、肌钙蛋白T（Tn-T）和肌钙蛋白I（Tn-I）。
将19例选择性冠状动脉支架置入术与1995年3月至6月在我们实验室进行的25例匹配的传统经皮腔内冠状动脉成形术（PTCA）进行比较。排除正在发生或近期（<2周）心肌梗死、慢性完全闭塞和隐静脉移植血管扩张的病例。根据定义，所有患者均顺利植入单个帕尔马兹-施查茨支架，术后无胸痛且心电图无持续变化。在基线以及术后6、12和24小时测定CK-MB质量、Tn-T和Tn-I的血清水平。确定每个标志物异常结果的频率。比较两组的基线和术后峰值水平，并与手术变量相关联。
所有病例的基线值均正常。定量分析表明，两组中每个标志物（包括总CK）的术后水平相对于基线均显著升高。在支架组中，2例患者CK-MB质量呈阳性，4例Tn-T呈阳性，7例Tn-I呈阳性。Tn-T和Tn-I的绝对变化分别与CK-MB质量的变化密切相关（r = 0.76，P < 0.0001；r = 0.90，P < 0.0001）。这些患者中有3例发生临床无症状的分支闭塞。他们所有肌钙蛋白均呈阳性，2例CK-MB呈阳性。未发现手术变量与生化检测结果之间存在相关性。在PTCA组中，3例患者Tn-I呈阳性，而CK-MB质量和Tn-T始终正常。未观察到分支闭塞。支架组的CK-MB质量和Tn-I峰值显著高于PTCA组（分别为±4.1对±1.3 ng/ml，P = 0.0其差异在排除分支闭塞患者后不再明显。
在我们的系列研究中，Tn-I检测显示出检测MMD的最高能力，在37%的支架置入病例和14%的PTCA病例中呈阳性。选择性冠状动脉支架置入术比传统PTCA释放更多的CK-MB质量和Tn-I。这一发现主要由分支闭塞病例决定，分支闭塞病例占支架组围手术期MMD的大部分，但不是全部。
