Ohnishi N, Iwasaki K, Kusachi S, Hirami R, Matano S, Ohnishi H, Takeda K, Kita T, Sakakibara N, Tsuji T
First Department of Internal Medicine, Okayama University Medical School, Japan.
Jpn Heart J. 1998 Mar;39(2):139-46. doi: 10.1536/ihj.39.139.
The use of the serum troponin T (TnT) level as a means of assessing minor myocardial injury, which affects the long-term prognosis, has not been fully clarified in patients with coronary artery disease in whom a coronary stent has been implanted. We measured the TnT level to determine the incidence of myocardial damage associated with stent implantation. A total of 29 patients who underwent successful stent implantation (stenting group) were studied and compared with 45 patients who underwent successful coronary balloon angioplasty during the same period (balloon angioplasty group). The serum TnT level was measured by enzyme immunoassay 36 hours after the stenting or balloon angioplasty. The activities of serum creatine kinase (CK) and its isoenzyme MB (CK-MB) were measured by a modified Rosalski method and an immunoinhibition method, respectively, before, immediately after, and 6, 12, and 24 hours after the procedure. Elevation of the TnT level was found in 3.4% (1/29; 0.35 ng/ml) of the patients in the stenting group and in 8.9% (4/45; 0.75 +/- 0.21 ng/ml) of those in the balloon angioplasty group. Elevation of the CK and CK-MB activities was found in 3.4% (1/29; 163 IU/l) and 0%, respectively in the stenting group, and 15.5% (7/45; 375 +/- 143 IU/l) and 4.4% (2/45; 24 and 49 IU/l), respectively, in the balloon angioplasty group. TnT elevation was not invariably accompanied by CK or CK-MB elevation, or by angiographically visible side branch occlusion. For TnT, CK-MB activity and CK activity, there was no significant difference between in the incidence of elevation in the balloon angioplasty group and that in the stenting group. In summary, the incidence of myocardial damage associated with stent implantation seems to be low and comparable to that associated with balloon angioplasty. Despite the low incidence, measurement of the serum TnT level in addition to CK-MB measurement is essential in assessing minor myocardial damage.
血清肌钙蛋白T（TnT）水平作为评估影响长期预后的轻微心肌损伤的一种手段，在已植入冠状动脉支架的冠心病患者中尚未完全阐明。我们测量了TnT水平，以确定与支架植入相关的心肌损伤发生率。共研究了29例成功进行支架植入的患者（支架植入组），并与同期45例成功进行冠状动脉球囊血管成形术的患者（球囊血管成形术组）进行比较。在支架植入或球囊血管成形术后36小时通过酶免疫测定法测量血清TnT水平。分别在手术前、术后即刻以及术后6、12和24小时，通过改良的罗萨尔斯基法和免疫抑制法测量血清肌酸激酶（CK）及其同工酶MB（CK-MB）的活性。支架植入组中3.4%（1/29；0.35 ng/ml）的患者TnT水平升高，球囊血管成形术组中8.9%（4/45；0.75±0.21 ng/ml）的患者TnT水平升高。支架植入组中CK和CK-MB活性升高的比例分别为3.4%（1/29；163 IU/l）和0%，球囊血管成形术组中分别为15.5%（7/45；375±143 IU/l）和4.4%（2/45；24和49 IU/l）。TnT升高并不总是伴有CK或CK-MB升高，也不伴有血管造影可见的侧支闭塞。对于TnT、CK-MB活性和CK活性，球囊血管成形术组和支架植入组升高发生率之间无显著差异。总之，与支架植入相关的心肌损伤发生率似乎较低，与球囊血管成形术相关的发生率相当。尽管发生率较低，但在评估轻微心肌损伤时，除测量CK-MB外，测量血清TnT水平也至关重要。
