Evaluation of cardiac troponin-T activity after PTCA with and without stenting in patients with stable angina pectoris

ABSTRACT

To detect the minor myocardial injury in patients undergoing elective successful PTCA with and without stenting using Troponin- T [Tn- T] and CK-MB immuno- assay in stable angina pectoris.There is a controversy as to the source and significance of mild elevation of creatine kinase isoenzyme MB activity [CK - MB] and myoglobin in patient undergoing successful PTCA. While, cardiac troponin-T is a unique myocardial antigen that is released in circulation during ischemia it can be readily differentiated from the skeletal muscle isoform. Increase of Tn-T may occur for a variety of reasons in PTCA with stenting. So, Tn-T and CK-MB assay had proved useful as a diagnostic tools in detecting minor ischemic myocardial damage in unstable angina pectoris.40 patients with stable angina pectoris were arranged in two groups; group I; 20 patients [17 M and 3 F] underwent PTCA only, and group II; 20 patients [18 M and 2F] underwent PTCA with stenting. Excluded from the study are patients with AMI, unstable angina, elevated cardiac enzymes before cardiac catheterization, other cardiacvascular diseases [valvular, cardiomyopathy, and pericardial diseases], conduction defect [RBBB, LBBB and third degree heart block], and pace rhythm.The selected patients [40] were subjected to; history taking clinical examination, 12 leads resting ECG, echo-Doppler examination, laboratory investigations, chest x-ray and cardiac catheterization for angiography and PTCA [with or without stenting]. Total CK, CK- MB and LDH were measured before and every 6 hours after PTCA for 24 hours. Tn- T was measured before, 6 hours and 24 hours after PTCA. Total CK was elevated in 12.5% in patients of both groups; it was elevated by 15% in group I versus 10% in group II. Patients with elevated total CK had elevated Tn-T [40%]. CK-MB was elevated by 10% of patients in both groups, it was elevated in 3 patients [15%] in group I and in one patient [5%] in group II, all patients with elevated CK-MB had elevated Tn-T [100%]