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      Relationship of Serum Cardiac Markers following Successful Percutaneous Coronary Intervention and Subsequent Exercise Capacity in Patients with Chronic Stable Angina: A Pilot Study


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          We performed a pilot study to assess the significance of modest, asymptomatic, elevated serum cardiac markers – troponin T (TnT) and creatinine kinase-MB (CK-MB) – 18–24 h following successful elective percutaneous coronary intervention (PCI) and to explore their relationship with changes in aerobic exercise capacity, as measured by peak oxygen consumption (VO<sub>2</sub>), 6 weeks following the procedure. Twenty-three patients with single-vessel disease and chronic angina performed an incremental cardiopulmonary exercise test before and 6 weeks after successful uncomplicated PCI. A venous blood sample was taken at rest before PCI and 18–24 h after the procedure. Successful PCI resulted in a trend towards an increased peak VO<sub>2</sub> [21.62 ± 0.64 (pre) vs. 23.03 ± 0.75 ml/ kg/min (post), p = 0.07; mean ± SEM]. There was a significant increase [median (IQR)] in TnT, from 0.00 (0.00) µg/l at baseline increasing to 0.02 (0.03) µg/l at 18–24 h, p = 0.002. CK-MB levels showed no significant difference. In the group of 15/23 (65%) patients with an elevation in serum TnT (≧0.01 µg/l), 18–24 h after successful PCI, there was no significant increase in peak VO<sub>2</sub> [23.31 ± 0.96 (pre) vs. 23.89 ± 1.09 ml/kg/min (post), p = 0.57]. In 8 (35%) patients with no rise in TnT at 18–24 h, a significant increase in peak VO<sub>2</sub> was observed following successful PCI [23.10 ± 0.91 (pre) vs. 25.09 ± 0.75 ml/kg/min (post), p = 0.02]. Although 7 of these 8 patients increased their peak VO<sub>2</sub>, the absence of a TnT rise at 18–24 h was not significantly associated with an increase in peak VO<sub>2</sub> following successful PCI (p = 0.18). To confirm these interesting initial results and investigate the relationship of serum cardiac markers following successful PCI and subsequent exercise capacity, further studies are required.

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          Most cited references 11

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          Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials.

          To determine whether percutaneous transluminal coronary angioplasty (angioplasty) is superior to medical treatment in non-acute coronary artery disease. Meta-analysis of randomised controlled trials. Randomised controlled trials conducted worldwide and published between 1979 and 1998. 953 patients treated with angioplasty and 951 with medical treatment from six randomised controlled trials, three of which included patients with multivessel disease and pre-existing myocardial infarction. Angina, fatal and non-fatal myocardial infarction, death, repeated angioplasty, and coronary artery bypass grafting. In patients treated with angioplasty compared with medical treatment the risk ratios were 0. 70 (95% confidence interval 0.50 to 0.98; heterogeneity P<0.001) for angina; 1.42 (0.90 to 2.25) for fatal and non-fatal myocardial infarction, 1.32 (0.65 to 2.70) for death, 1.59 (1.09 to 2.32) for coronary artery bypass graft, and 1.29 (0.71 to 3.36; heterogeneity P<0.001) for repeated angioplasty. Differences in the methodological quality of the trials, in follow up, or in single versus multivessel disease did not explain the variability in study results in any analysis. Percutaneous transluminal coronary angioplasty may lead to a greater reduction in angina in patients with coronary heart disease than medical treatment but at the cost of more coronary artery bypass grafting. Trials have not included enough patients for informative estimates of the effect of angioplasty on myocardial infarction, death, or subsequent revascularisation, though trends so far do not favour angioplasty.
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            Frequency and long-term impact of myonecrosis after coronary stenting.

            To study the frequency of creatine kinase MB elevation in stent recipients and to correlate the magnitude of myonecrosis with long-term ischaemic events. We evaluated the frequency and impact (major adverse ischaemic events) of creatine kinase MB elevation in 3478 patients undergoing planned coronary stenting and divided them in five strata according to peak creatine kinase MB: normal, 1-3 x, 3-5 x, 5-10 x and >10 x above upper limit of normal. Graft intervention was done in 15% and 61% received platelet glycoprotein IIb/IIIa receptor inhibitors. The average follow-up period was 15+/-15 (range 1-72) months. Creatine kinase MB elevation above upper limit of normal occurred in 24% and in 5.3% it was greater than 5 x upper limit of normal. The unadjusted rates of actuarial mortality in the five strata were: 7.5% (198/2637), 8.0% (40/502), 11.0% (17/155), 10.8% (11/102) and 29.3% (24/82), respectively, P<0.001. Logistic regression analysis including 18 demographic and procedural variables revealed that, in addition to age, extent of coronary disease, ventricular function and coronary risk profile, creatine kinase MB elevation was associated with a significant increase in major ischaemic events at follow-up. The excess risk was concentrated mainly in the highest stratum of creatine kinase MB elevation. Thus, in the era of stenting and aggressive adjunctive pharmacology, peri-procedural myonecrosis still remains frequent and has an important impact on long-term event-free survival. Intensive efforts to reduce creatine kinase MB elevation after revascularization are warranted and should lead to important benefits. Copyright 2001 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
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              Minor myocardial injury after elective uncomplicated successful PTCA with or without stenting: detection by cardiac troponins.

              Cardiac troponins are sensitive and specific markers for the detection of minor myocardial injury. However, they have been rarely used to monitor myocardial injury after coronary stenting. The purpose of the study was to measure cardiac troponin I (cTnI) and cardiac troponin T (cTnT) levels after elective uncomplicated successful percutaneous transluminal coronary angioplasty (PTCA) with or without coronary stenting and to compare their results with serum creatinine kinase MB isoenzyme (CKMB). CTnI and cTnT levels were compared with those of CK or CKMB in 98 consecutive patients with stable angina undergoing elective uncomplicated successful PTCA with stenting (n = 71) or without stenting (n = 27). Markers were measured before and 6, 12, 24, and 48 hr after the procedure. Peak postprocedural levels for each marker were compared and related to angiographic and procedural characteristics as well as to the occurrence of side-branch occlusion. None of the patients had abnormal markers before the procedure. Abnormal postprocedural values of one or more markers were observed in 28 patients (29%), 23 after stenting and 5 after PTCA alone. The frequencies of abnormal cTnI and cTnT levels were significantly higher than that of CKMB after coronary intervention (26% and 18% vs. 7%; P = 0.00016 and 0.015, respectively), with cTnI being the most significant. When compared with troponin-negative patients, abnormal cardiac troponin values were significantly related to total time of inflation (223 +/- 128 vs. 170 +/- 105 sec; P = 0.008) and inflation maximal pressure (12.9 +/- 2.3 vs. 12.0 +/- 2.7 atm; P = 0.04). Small side-branch occlusion was noticed in 36% of the troponin-positive patients and in 6% of the troponin-negative group (P = 0.00047). In conclusion, minor myocardial injury is not uncommon after elective uncomplicated successful PTCA with or without stenting. Cardiac troponins, especially cTnI, are more sensitive than CKMB for the detection of this minor myocardial injury. Total time of inflation and inflation maximal pressure are predictors of postprocedural elevation of cardiac troponins. Side-branch occlusion may account for some, but not all, periprocedural minor myocardial injury.

                Author and article information

                S. Karger AG
                February 2005
                07 February 2005
                : 103
                : 2
                : 63-67
                aCardiothoracic Centre, Liverpool, bDepartment of Mathematical Sciences, University of Liverpool, Liverpool, cMolecular Vascular Medicine, Chemical Biochemistry and Cardiology Departments, Leeds General Infirmary, Leeds, UK
                82049 Cardiology 2005;103:63–67
                © 2005 S. Karger AG, Basel

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                Page count
                Tables: 4, References: 18, Pages: 5
                General Cardiology


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