Document Detail


The impact of micro troponin leak on long-term outcomes following elective percutaneous coronary intervention.
MedLine Citation:
PMID:  19670308     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: 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). BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors:
Richard V Milani; Robert Fitzgerald; Jenna N Milani; Carl J Lavie
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  74     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-17     Completed Date:  2010-01-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  819-22     Citation Subset:  IM    
Copyright Information:
Copyright 2009 Wiley-Liss, Inc.
Affiliation:
Department of Cardiovascular Disease, Ochsner Health System, New Orleans, Louisiana 70121, USA. rmilani@ochsner.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects*,  mortality
Biological Markers / blood
Coronary Artery Disease / therapy*
Disease-Free Survival
Female
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction / blood,  etiology*,  mortality,  pathology
Myocardium / metabolism*,  pathology
Necrosis
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Troponin / blood*
Up-Regulation
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Troponin
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2009 Nov 15;74(6):823-5   [PMID:  19902503 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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