Genser N, Mair J, Talasz H, Puschendorf B, Calzolari C, Larue C, Friedrich G, Moes N, Muehlberger V
Department of Medical Chemistry, University of Innsbruck, Austria.
Clin Chim Acta. 1997 Sep 30;265(2):207-17. doi: 10.1016/s0009-8981(97)00118-6.
The purposes of the present study were to evaluate cardiac troponin 1 (cTnl) in the diagnosis of percutaneous transluminal coronary angioplasty (PTCA)-related myocardial injury in comparison with cardiac troponin T (cTnT) and creatine kinase (CK) MB mass concentration, and to investigate the frequency of myocardial injury, as indicated by myocardial protein release, after clinically symptomless side-branch occlusion (SBO) which may occur in the proximity of the attempted stenosis. The final study population comprised 80 patients undergoing elective, single vessel PTCA. Blood samples were drawn before, 6, 24 and 48 h after PTCA. cTnI, cTnT and CKMB mass baseline values were within the reference intervals in all patients (cTnI < 0.1 microgram/l, cTnT < 0.2 microgram/l, CKMB < 5 micrograms/l). Two patients presented with primary failure of PTCA, and visually successful PTCA was performed in all remaining patients. Seven patients (four with SBO) subsequently developed acute myocardial infarction (AMI). Symptomless SBO occurred in 16 patients. In controls (n = 55) there were no significant increases in cTnI, cTnT, or CKMB concentrations compared with baseline values, and all markers stayed within their reference intervals. In half the patients with symptomless SBO (n = 8) all markers were slightly to moderately increased, in two additional patients only CKMB was elevated (cTnI: 0.1-1.0 microgram/l; cTnT: 0.25-0.81 microgram/l and CKMB: 7.9-25.6 micrograms/l). In the majority of patients with primary failure or AMI we found pronounced increases in all tested markers (cTnI: 0.2-12.0 micrograms/l; cTnT: 0.44-12.10 micrograms/l; CKMB: 19.2-423.0 micrograms/l). The results of this study indicate that cTnI is comparably useful to cTnT or CKMB mass for diagnosing myocardial injury in PTCA patients. From our results a preference for one of the tested parameters cannot be clearly derived. Post-procedural cTnI, cTnT, and CKMB mass values are not higher than baseline values in uncomplicated cases, whereas AMI after PTCA leads to pronounced marker increases. SBO, even when symptomless, leads frequently (in about half the patients) to slight marker increases.
本研究的目的是，将心肌肌钙蛋白I（cTnl）与心肌肌钙蛋白T（cTnT）和肌酸激酶（CK）MB质量浓度相比较，以评估其在诊断经皮腔内冠状动脉成形术（PTCA）相关心肌损伤中的作用，并调查在试图进行狭窄治疗部位附近可能发生的无症状侧支闭塞（SBO）后，心肌蛋白释放所表明的心肌损伤频率。最终的研究人群包括80例行择期单支血管PTCA的患者。在PTCA前、术后6小时、24小时和48小时采集血样。所有患者的cTnI、cTnT和CKMB质量基线值均在参考区间内（cTnI<0.1微克/升，cTnT<0.2微克/升，CKMB<5微克/升）。2例患者PTCA原发失败，其余所有患者PTCA手术视觉上成功。7例患者（4例发生SBO）随后发生急性心肌梗死（AMI）。16例患者发生无症状SBO。在对照组（n=55）中，与基线值相比，cTnI、cTnT或CKMB浓度无显著升高，所有标志物均保持在参考区间内。在一半无症状SBO患者（n=8）中，所有标志物均有轻度至中度升高，另外2例患者仅CKMB升高（cTnI：0.1 - 1.0微克/升；cTnT：0.25 - 0.81微克/升；CKMB：7.9 - 25.6微克/升）。在大多数原发失败或AMI患者中，我们发现所有检测标志物均有显著升高（cTnI：0.2 - 12.0微克/升；cTnT：0.44 - 12.10微克/升；CKMB：19.2 - 423.0微克/升）。本研究结果表明，在诊断PTCA患者的心肌损伤方面，cTnI与cTnT或CKMB质量同样有用。从我们的结果中无法明确得出对所测试参数之一的偏好。在未发生并发症的情况下，术后cTnI、cTnT和CKMB质量值不高于基线值，而PTCA后发生AMI会导致标志物显著升高。SBO即使无症状，也经常（约半数患者）导致标志物轻度升高。
