value of cardiac troponin I as a predictor of cardiac events after percutaneous coronary intervention

Elevation of cardiac troponin I [cTnI] is not uncommon after coronary interventions. Many studies tried to find factors responsible for this elevation and its prognosis on short and long term follow up. Whether or not elevation of cardiac troponin post coronary interventions is responsible for early in hospital and late adverse outcome is still under debate. To identify different predictors of cardiac troponin I elevation after coronary interventions, and to assess the relation between cardiac troponin I elevation post coronary interventions and [early and late] adverse clinical outcome. The study included 50 consecutive patients who underwent coronary angioplasty with stenting in the Cardiac Catheterization Laboratory at Benha University Hospital during the period from December 2004 to December 2005. Full medical history and clinical data were obtained from the patients with special emphasis on the major documented risk factors for coronary artery disease [CAD] [age, sex, obesity, smoking, diabetes mellitus, hypertension, hypercholesterolemia, positive family history of CAD], and history of previous myocardial infarction [MI] or anginal attack. Twelve-lead standard surface electrocardiogram [ECG] was done routinely before and after intervention, echocardiography was also done to determine the global left ventricular systolic function, and coronary angiography was done for all patients and angiographic analysis was performed. Stenosis was considered when there was > 75% reduction in luminal diameter at coronary angiography. Quantitative measurements of the target lesion was performed before intervention by measurement of the lesion length, minimal luminal diameter and reference diameter. Percutaneous Coronary Intervention [PCI] was done and stenting for all patients . The procedure was considered successful when the residual stenosis in the dilated segment was less than 20%. Troponin I and CK-MB were measured 2 hours before the procedure and 8 and 24 hours after the procedure by immuno-inhibition based on the change in troponin I and CK-MB level. The patients were divided into 2 groups: Group I: No elevation of cTnI [0.4ng/l] and, Group II: cTnI [>0.4 ng/l], which was subdivided into Group IIA: with elevated cTnI + CK-MB > 25 IU/L, and Group IIB: with elevated cTnI + CK-MB 25 IU/L. New ST depression and T wave abnormalities post procedural were predictive of post procedural elevation of cardiac troponin I after PCI [p < 0.05]. Parameters of quantitative angiographic analysis of the lesions including preprocedural minimal luminal diameter [p < 0.01], diameter stenosis [p < 0.01] and post procedural minimal luminal diameter [p<0.01] and diameter stenosis [p < 0.05] were strongly associated with post procedural cardiac troponin I elevation. Shorter stent length was also associated with cardiac troponin I elevation post cath. [p < 0.01]. Positive predictive value of cardiac troponin I post procedural for early complications was 23.1% and negative predictive value was l00%. Concordant cardiac troponin I and CK-MB elevation post procedural were strong predictors for early in hospital complications [p<0.01]. Positive predictive value for concordant cTnI and CK-MB elevation for early complications was 60% and negative predictive value was 100%. No association was found between cardiac troponin 1 elevation post cath or concordant elevation of cardiac troponin I and CK-MB elevation with late adverse clinical outcome

Comparison of stenting with minimally invasive bypass surgery for high grade stenosis of the proximal left anterior descending coronary artery: six months follow up of randomized study

High grade stenosis of the proximal left anterior descending coronary artery [LAD] in patients with single-vessel disease is associated with a significantly worse prognosis than lesions at any other location. To compare the merits of stenting with minimally invasive coronary artery bypass [MICAB] surgery for high grade stenosis of isolated proximal LAD. One hundred patients with isolated high grade lesion [stenosis] >75% of laminal diameter in the proximal LAD were included. The patients were classified into two groups: Group A included 50 patients in whom successful stenting was performed. Group B included 50 patients in whom successful MICAB was performed. In group A the mean percentage of stenosis was significantly reduced to 10.48 +/- 4.112. After stenting, non of the patients died, 2Q wave infarction, 2 non Q wave infarction and 1 required coronary bypass surgery, 1 stroke, 3 LAD dissection, 5 angina pectoris, 3 needed revascu-larization, 4 vascular complications and 4 needed blood transfusion. In group B, after surgery 1 patient had Q wave infarction, 1 non Q wave infarction, 2 patients needed necessary sternotomy because of an intramyocardial segment of the LAD, 3 angina pectoris, 2 needed revascularization, 2 vascular complications, 2 needed blood transfusion, 2 developed AF and 2 chest wall hernias. The mean duration of lCU stay after surgery was 2.62 +/- 1.086 days as compared to 1.8 +/- 1.591 days after stenting [p < 0.05], the mean duration of hospitalization after surgery was 8.64 +/- 3.186 days as compared to 2.34 +/- 2.471 days after stenting [p < 0.01], Follow-up was complete for all patients except two patients in each group [2 patients died in group B while in group A one patients traveled and other was excluded, eleven asymptomatic patients refused repeated cardiac catheterization after stenting, as did 13 patients after surgery. No statistically significant difference was found between both groups as regard to positive exercise stress test [p > 0.05]. After stenting, the angina class improved 79.2% were free of angina. After surgery, the mean angina class improved, 91.6% of patients were free of angina. After six months of follow up, in-stent restenosis was detected in 11 patients [29.7%] and subgroup analysis showed a restenosis rate 15.4 for type B lesion and 46.2% for type C lesion. The recurrence of stenosis was more in type C and B than type A in stenting group. In surgical group, 3 patients [8.6%] had stenosis > 50% of the luminal diameter at the anatomic region, and subgroup analysis showed a restenosis rate of 3.6% for type B lesions and 21.4% for type C lesions. The recurrence of stenosis was more in type C and B than type A in surgical group. Secondary end points were 56% in group A vs 26% in group B. Stenting and minimally invasive bypass surgery are safe and effective treatment options for high grade lesions in the proximal LAD; MICAB requires longer hospitalization, more cost but has better an-giographic outcome while stenting has higher target vessel revascularization and secondary adverse cardiac event than MICAB