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• W2035522505 abstract "HomeCirculationVol. 105, No. 12Prognostic Implications of Cardiac Marker Elevation After Percutaneous Coronary Intervention Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBPrognostic Implications of Cardiac Marker Elevation After Percutaneous Coronary Intervention Thuraia Nageh, Roy A. Sherwood and Martyn R. Thomas Thuraia NagehThuraia Nageh King’s College Hospital, Denmark Hill, London, UK Search for more papers by this author , Roy A. SherwoodRoy A. Sherwood King’s College Hospital, Denmark Hill, London, UK Search for more papers by this author and Martyn R. ThomasMartyn R. Thomas King’s College Hospital, Denmark Hill, London, UK Search for more papers by this author Originally published26 Mar 2002https://doi.org/10.1161/01.CIR.0000012245.51323.59Circulation. 2002;105:e73To the Editor:We read with interest the report by Stone et al1 that showed a highly significant association between the development of Q-wave myocardial infarction (QWMI) and creatine kinase (CK)-MB values >8 times the upper limit of normal after percutaneous intervention (PCI) with in-hospital and late (up to 2 years) mortality.Evidence of an increased risk of adverse clinical outcome with asymptomatic rises of CK and CK-MB after PCI has previously been clearly documented.2,3 We studied the release of the highly sensitive and specific cardiac troponin I (cTnI) in a series of 344 consecutive patients presenting with stable angina and undergoing elective PCI (balloon angioplasty, stent insertion, and rotational atherectomy).4 We measured cTnI before PCI and at 6, 14, and 24 hours after PCI. cTnI was elevated in 61 (17.7%) patients after PCI in our series, which was comparable to a postprocedural CK-MB rise in 17.9% of patients in the study by Stone et al.1We found a post-PCI cTnI elevation of >0.2 μg/L (manufacturers’ recommended clinically discriminant value) to be strongly predictive of adverse events (death, QWMI, and repeat revascularization) at a mean follow-up period of 44.5 (±17.7) weeks. The positive predictive value (PPV) of post-PCI cTnI elevation for adverse events was 0.47, and the negative predictive value (NPV) was 0.96 (P<0.0001; OR 18.9, 95% CI 9.7 to 37).This association seemed to be independent of angiographic procedural complications. Angiographic events occurred in 79 (23%) of our patients. In 40 (15%) of the remaining 265 patients, cTnI was elevated to >0.2 μg/L within 24 hours after PCI in the absence of angiographic complications. The occurrence of angiographic complications had a PPV for adverse events of 0.30 and a NPV of 0.93 (P=0.0003; OR 4.4, 95% CI 2.2 to 8.6). The combination of both angiographic complications and postprocedural cTnI elevation gave a PPV for adverse events of 0.69 and a NPV of 0.92 (P=0.005; OR 22.6, 95% CI 2.6 to 68.5). We did not demonstrate a significant relationship between the type of procedural device and postprocedural cTnI elevation.Our data add to a growing body of evidence showing that asymptomatic postprocedural myocardial cell injury does have important prognostic implications and would support the need for routine troponin measurements after PCI. References 1 Stone GW, Mehran R, Dangas G, et al. Differential impact on survival of electro-cardiographic Q wave versus enzymatic myocardial infarction after percutaneous intervention. Circulation. 2001; 104: 642–647.CrossrefMedlineGoogle Scholar2 Abdelmeguid AE, Topol EJ, Whitlow PL, et al. Significance of mild transient release of creatine kinase-MB fractions after percutaneous coronary interventions. Circulation. 1996; 94: 1528–1536.CrossrefMedlineGoogle Scholar3 Tardiff BE, Califf RM, Tchong JE, et al. Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention. IMPACT-II Investigators. J Am Coll Cardiol. 1999; 33: 88–96.CrossrefMedlineGoogle Scholar4 Nageh T, Harris BM, Sherwood RA, et al. The prognostic value of cardiac troponin I following coronary artery intervention. Eur Heart J. 2000; 21: 501.Abstract.Google Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Sardi G, Laynez-Carnicero A, Torguson R, Xue Z, Suddath W, Kent K, Satler L, Pichard A, Lindsay J and Waksman R (2013) The independent value of a direct stenting strategy on early and late clinical outcomes in patients undergoing elective percutaneous coronary intervention, Catheterization and Cardiovascular Interventions, 10.1002/ccd.24581, 81:6, (949-956), Online publication date: 1-May-2013. Ferguson M, Romick B, Carter L and De Geare V (2005) Relation of the use of lipid-lowering medications prior to percutaneous coronary intervention to the incidence of intraprocedural adverse angiographic events⁎⁎No grants, contracts, foundations, or other forms of financial support were involved in this work. The authors have no financial interests or relevant affiliations with private or public institutions that would present a conflict of interest in the findings of this work., The American Journal of Cardiology, 10.1016/j.amjcard.2004.12.040, 95:8, (978-980), Online publication date: 1-Apr-2005. Salamonsen R, Schneider H, Bailey M and Taylor A (2005) Cardiac Troponin I Concentrations, but Not Electrocardiographic Results, Predict an Extended Hospital Stay after Coronary Artery Bypass Graft Surgery, Clinical Chemistry, 10.1373/clinchem.2004.041103, 51:1, (40-46), Online publication date: 1-Jan-2005. Ramı́rez-Moreno A, Cardenal R, Pera C, Pagola C, Guzmán M, Vázquez E, Fajardo A, Lozano C, Solı́s J and Gassó M (2004) Predictors and prognostic value of myocardial injury following stent implantation, International Journal of Cardiology, 10.1016/j.ijcard.2003.07.031, 97:2, (193-198), Online publication date: 1-Nov-2004. March 26, 2002Vol 105, Issue 12 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000012245.51323.59PMID: 11914268 Originally publishedMarch 26, 2002 PDF download Advertisement" @default.
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