Troponin T elevation after successful directional atherectomy

Citation
E. Giannitsis et al., Troponin T elevation after successful directional atherectomy, Z KARDIOL, 90(6), 2001, pp. 401-407
Citations number
27
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
ZEITSCHRIFT FUR KARDIOLOGIE
ISSN journal
0300-5860 → ACNP
Volume
90
Issue
6
Year of publication
2001
Pages
401 - 407
Database
ISI
SICI code
0300-5860(200106)90:6<401:TTEASD>2.0.ZU;2-N
Abstract
Background The incidence and correlates of postinterventional cardiac tropo nin T (cTnT) elevation have not been evaluated in patients with successful directional atherectomy (DCA). Methods Total creatine kinase (CK) activity, CK-MB mass concentrations and cTnT levels were measured in 36 patients bef ore, and serially 4, 24, 48 and 72 hours after successful DCA. Patients wer e followed for death, Q-wave infarction, need for emergency bypass surgery periprocedural vascular complications (transient in-lab vessel closure, sid e branch compromise, large dissection), and non-Q-wave infarction on EGG. P atients were followed for clinical outcomes and angiographic restenosis for 6 months. Vascular correlates were studied by coronary angiography and int ravascular ultrasound before, immediately after and 4 hours after elective and successful DCA. Results 25 patients (69.4%) had elevated levels of cTnT , whereas CK-MB mass greater than or equal to 6 ng/ml and mild elevations o f total CK activity were present in only 36.1 and 5.6%, respectively. Eleva ted cTnT was related to vascular complications in 44% of cases. Inapparent microembolization of platelets or plaque debris was considered responsible for most of the remaining microne-croses. During 6 month follow-up rates of clinical restenosis (44 vs 9%, p = 0.059) tended to be higher in patients with as compared to patients without CTnT release after DCA. Conclusion Suc cessful DCA is associated with postprocedural elevations of cTnT which rela te to minor vascular complications and presumably microembolization of plat elets or plaque debris. The superior diagnostic performance of cTnT compare d to CK-MB mass may relate to more sensitive identification of microinfarct ion. Further studies are mandatory to confirm the association between eleva tion of cTnT and risk of restenosis and TVR.