Myocardial damage during percutaneous transluminal coronary angioplasty as evidenced by troponin T measurements

Johansen, Odd; Brekke, Milo L.; Strømme, J H; Valen, V.; Seljeflot, I; Skjaeggestad, O; Arnesen, Harald

doi:10.1053/euhj.1997.0732

Cited by 46 publications

(32 citation statements)

References 17 publications

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“…[16][17][18][19] The incidence of TnT release exceeding the cut-off point in the control group of our study was 42%, which is similar to that (44%) reported by Karim, et al 16) but higher than those (13% and 8.9%, respectively) reported by Shyu, et al 17) and Ohnishi, et al 19) The difference in the incidence of TnT release may be due to the difference in the total balloon inflation time during angioplasty. 18) Intracoronary pressure-derived CFI has often been used for evaluating coronary collateral function during coronary angioplasty. 14) We have revealed that nicorandil-induced preconditioning during coronary angioplasty is independent of collateral recruitment using the same CFI.…”

Section: Discussionsupporting

confidence: 84%

“…However, other similar studies followed TnT levels in patients undergoing elective coronary angioplasty for more than 24 hours. [16][17][18][19] The peak values of TnT elevation may have been seen after an 18-hour rest period in this study. The stenotic lesion was located in one of the three major coronary arteries, therefore, some potential differences in TnT release due to the lesion site were not considered.…”

Section: Vol 43 Nomentioning

confidence: 48%

“…15) Several studies have shown that TnT elevation is observed in some patients undergoing elective coronary angioplasty, indicating that the elevation reflects minor myocardial damage. [16][17][18][19] Moreover, TnT has been shown to be more sensitive and specific than creatine kinase-MB for the detection of myocardial damage after angioplasty. 16,17) The aim of the present study was to examine the preconditioning effect of nicorandil on TnT release after coronary angioplasty in patients with stable angina pectoris.…”

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confidence: 99%

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Nicorandil-Induced Preconditioning as Evidenced by Troponin T Measurements after Coronary Angioplasty in Patients with Stable Angina Pectoris.

et al. 2002

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SUMMARYNicorandil has been reported to have a preconditioning effect which suppresses the ST-segment shift or lactate production during coronary angioplasty in patients with stable angina pectoris. The present study investigated whether the preconditioning effect of nicorandil affects troponin T (TnT) levels after coronary angioplasty. Twenty-four patients with stable angina pectoris were randomized to receive a 1-minute intravenous infusion of nicorandil (100 µg/kg) or normal saline. Five minutes later they underwent three 2-minute balloon inflations 5 minutes apart. The sum of ST-segment elevation in all leads (∑ST) was determined at the end of each balloon inflation. Serum levels of TnT were measured 6 and 18 hours after the procedure, and the higher value of the two measurements was compared between the groups. ∑ST decreased progressively during the three sequential balloon inflations in both groups and was less in the nicorandil group than in the control group. The TnT level after the procedure was significantly lower in the nicorandil group than in the control group (0.05±0.05 vs 0.11±0.10 ng/mL). In conclusion, pretreatment with intravenous nicorandil suppresses TnT release after coronary angioplasty as well as ST-segment elevation during coronary angioplasty, suggesting pharmacological preconditioning by nicorandil. (Jpn Heart J 2002; 43: 443-453)

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Section: Discussionsupporting

confidence: 84%

Section: Vol 43 Nomentioning

confidence: 48%

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confidence: 99%

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Nicorandil-Induced Preconditioning as Evidenced by Troponin T Measurements after Coronary Angioplasty in Patients with Stable Angina Pectoris.

et al. 2002

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“…25 Similar procedural injury to the heart has been extensively documented secondary to coronary interventions by measurements of elevations in troponin levels (so-called troponin "leak") and constitutes justification for the current stringent training standards for coronary intervention. 26,27 In addition to the technical risks of cerebrovascular procedures, there is also a risk of misdiagnosis if images are not interpreted correctly. This fact justifies formal and adequate cognitive training related to neurological and neurovascular anatomy, neurodiagnostic imaging, and neuro-pathophysiology.…”

Section: Risks Of Cervicocerebral Angiographic Procedures Risks Of Dmentioning

confidence: 99%

Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention

Connors

Sacks

Furlan³

et al. 2005

Neurology

101

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Appropriate and adequate cognitive and technical training, proficiency and experience are essential for the safe performance of procedures that confer significant risk to patient well-being. This principle is the foundation of all medical education and is especially important when considering the cerebral vasculature, for which stroke is a defined risk for every endovascular procedure. Despite recent advances in noninvasive diagnostic neuroimaging, diagnostic cervicocerebral angiography remains the cornerstone and "gold standard" for the evaluation and treatment of patients with cerebrovascular disease.1 In addition to a high level of technical expertise, performance and interpretation of diagnostic cervicocerebral angiography requires in-depth cognitive knowledge of related neurological pathophysiology, neurovascular anatomy and pathology, and an understanding of the full range of neurodiagnostic possibilities. Expert diagnostic cervicocerebral angiography is the foundation for safe and successful cervicocerebral endovascular intervention, including carotid artery angioplasty and stenting for atherosclerosis, interventional stroke therapy, intracranial angioplasty and stenting, and embolization of cerebral aneurysms, epistaxis and vascular malformations. All of these procedures are increasing in volume and complexity with recent technological advances that further mandate the need for adequate cognitive acumen and technical skills. To ensure proper outcomes, formal neuroscience training, adequate procedural training and sufficient experience are all essential for competency in diagnostic cervicocerebral angiography and interventional procedures, including carotid stenting. These concepts have been delineated in training requirements by the Accreditation Council for Graduate Medical Education (ACGME) and by previously published official society statements. The purpose of this document is to define the minimum training and See also page 188 *These organizations represent all clinical medical specialties with formal accredited ACGME-approved training in the cervicocerebral vasculature and associated neurological pathophysiology. The executive committees and governing bodies of each organization have approved this document. †Authors/reviewers for the NeuroVascular Coalition Writing Group are listed in the Appendix.

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“…Studies have documented that elevation of postprocedural serum cardiac troponin is relatively common 1,2 and that markedly elevated levels of troponin after PCI are prognostically significant 3,4 ; however, uncertainties remain about the mechanisms and functional significance of small troponin releases after PCI and the direct relationship between procedure-related troponin rise and the volume of myocardial tissue loss. Despite these concerns, current European Society of Cardiology/American College of Cardiology guidelines recognize elevation of cardiac troponin within 24 hours of a PCI procedure in the definition of myocardial infarction.…”

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confidence: 99%

Troponin Elevation After Percutaneous Coronary Intervention Directly Represents the Extent of Irreversible Myocardial Injury

et al. 2005

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Background-Although troponin elevation after percutaneous coronary intervention (PCI) is common, uncertainties remain about the mechanisms of its release and its relationship to the volume of myocardial tissue loss. Delayedenhancement MRI of the heart has been shown to reliably quantify areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac troponin release, we studied the incidence and extent of new irreversible injury in patients undergoing PCI and correlated it to postprocedural changes in cardiac troponin I. Methods and Results-Fifty patients undergoing PCI were studied with preprocedural and postprocedural (24 hours) delayed-enhancement MRI for assessment of new irreversible myocardial injury. Cardiac troponin I measurements were obtained before PCI and 24 hours after PCI. Of these 50 patients, 24 underwent a further third MRI scan at a median of 8 months after the procedure. Mean patient age was 64Ϯ12 years. After the procedure, 14 patients (28%) had evidence of new myocardial hyperenhancement, with a mean mass of 6.0Ϯ5.8 g, or 5.0Ϯ4.8% of total left ventricular mass. All of these patients had raised troponin I levels (range 1.0 to 9.4 g/L). Thirty-four patients (68%) had no elevated troponin I and no evidence of new myocardial necrosis on MRI. There was a strong correlation between the rise in troponin I measurements at 24 hours and mean mass of new myocardial hyperenhancement, both early (rϭ0.84; PϽ0.001) and late (rϭ0.71; PϽ0.001) after PCI, although there was a trend for a reduction in the size of PCI-induced myocardial injury in the late follow-up scan (Pϭ0.07). Conclusions-In the setting of PCI, patients demonstrating postprocedural elevation in troponin I have evidence of new irreversible myocardial injury on delayed-enhancement MRI. The magnitude of this injury correlates directly with the extent of troponin elevation.

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Myocardial damage during percutaneous transluminal coronary angioplasty as evidenced by troponin T measurements

Cited by 46 publications

References 17 publications

Nicorandil-Induced Preconditioning as Evidenced by Troponin T Measurements after Coronary Angioplasty in Patients with Stable Angina Pectoris.

Nicorandil-Induced Preconditioning as Evidenced by Troponin T Measurements after Coronary Angioplasty in Patients with Stable Angina Pectoris.

Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention

Troponin Elevation After Percutaneous Coronary Intervention Directly Represents the Extent of Irreversible Myocardial Injury

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