With the “Universal Definition,” Measurement of Creatine Kinase-Myocardial Band Rather Than Troponin Allows More Accurate Diagnosis of Periprocedural Necrosis and Infarction After Coronary Intervention

Lim, C.C.S.; Gaal, William J. van; Testa, Luca; Cuculi, Florim; Arnold, Jayanth R.; Karamitsos, Theodoros D.; Francis, Jane M; Petersen, Steffen E.; Digby, Janet E.; Westaby, Stephen; Antoniades, Charalambos; Kharbanda, Rajesh K.; Burrell, Louise M.; Neubauer, Stefan; Banning, Adrian P.

doi:10.1016/j.jacc.2010.07.058

Cited by 130 publications

(89 citation statements)

References 30 publications

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“…A small study of 32 patients reported that a 40-fold increase in the ULN was the optimal postprocedural cTnI cutoff for identifying a confluent area of PMI by late gadolinium enhancement. 28 Second, an analysis from the Evaluation of Drug Eluting Stents and Ischemic Events registry suggested that a cTn threshold of 20× ULN was the best cutoff to match the frequency of PMI diagnosed using the universal definition for CK-MB (3× ULN). 29 However, the latter analysis had several limitations that are not present in our study, such as the use of pooled data from multiple centers using different assays for cTn, lack of measurement of pre-PCI cTn values, and absence of long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention

Herrmann

Lennon

Jaffe³

et al. 2014

Circ: Cardiovascular Interventions

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Background-There is controversy about the diagnostic and prognostic significance of percutaneous coronary interventionrelated myocardial infarction, especially with the use of cardiac troponin T (cTnT). This analysis was designed to address the question of the presence and the level of a prognostic cTnT threshold. Methods and Results-We evaluated 5268 consecutive patients who underwent nonemergent percutaneous coronary intervention between 2000 and 2009 with a preprocedural cTnT level below the upper limit of normal (ULN, ≤0.01 ng/mL). Postprocedural cTnT and creatine kinase-MB mass levels (ULN, 6.7 ng/mL in men and 3.8 ng/mL in women) were found to be associated with 3-month mortality in Cox proportional hazard models (hazard ratio per doubling of cTnT, 1.24; 95% confidence interval, 1.08-1.43; P=0.003 and hazard ratio per doubling of creatine kinase-MB, 1.30; 95% confidence interval, 1.05-1.60; P=0.018), adjusted for the Mayo Clinic risk scores for in-hospital and postdischarge mortality. The optimal prognostic threshold for 3-month mortality was 25× ULN for cTnT (hazard ratio, 4.53; 99% confidence interval, 1.59-12.9; P<0.001), which provided similar information as a value of 5× ULN for creatine kinase-MB (hazard ratio, 4.31; 99% confidence interval, 1.27-14.6; P=0.002). The cumulative mortality rate was 0.6% at 91 days. Conclusions-A significant association of postpercutaneous coronary intervention cardiac biomarker elevation with a small number of postpercutaneous coronary intervention outcomes was noted for the early (first 91 days) follow-up period with an identifiable optimal threshold of 25× ULN (0.25, ng/mL) for cTnT, which provided similar early outcome information as a cutoff of 5× ULN for creatine kinase-MB. (Circ Cardiovasc Interv. 2014;7:533-542.)

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Section: Discussionmentioning

confidence: 99%

Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention

Herrmann

Lennon

Jaffe³

et al. 2014

Circ: Cardiovascular Interventions

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“…Nonetheless, LGE may not be detected in areas of very small myocardial injury. 7,[26][27][28] Hence, our data suggest that most myocardial territories distal to a CTO contain varying degrees of myocardial scar.…”

Section: Frequency Of Lge and Rwmamentioning

confidence: 99%

Frequency of Myocardial Infarction and Its Relationship to Angiographic Collateral Flow in Territories Supplied by Chronically Occluded Coronary Arteries

et al. 2013

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Background-Despite complete interruption of antegrade coronary artery flow in the setting of a chronic total occlusion (CTO), clinical recognition of myocardial infarction is often challenging. Using cardiac MRI, we investigated the frequency and extent of myocardial infarction in patients with CTO, and assessed their relationship with regional systolic function and the extent of angiographic collateral flow. Methods and Results-We included 170 consecutive patients (median age, 62 years) with angiographically documented CTO. Regional late gadolinium enhancement and wall motion score index were assessed by cardiac MRI with the use of a 17-segment model. Angiographic collateral flow was assessed by the collateral connection grade and the Rentrop score. Evidence of previous myocardial infarction was found in 25% of patients by ECG Q waves, in 69% by regional wall motion abnormality, and in 86% of patients by late gadolinium enhancement. Increased angiographic collateral flow was associated with a lower frequency of Q waves on ECG, and a lower regional wall motion score index, late gadolinium enhancement volume (%), and degree of late gadolinium enhancement transmurality (all P<0.001), as well. Conclusions-The frequency of myocardial infarction in territories subtended

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“…From the pathophysiologic point of view heart rate, duration of SVT and mean arterial blood pressure, end-diastolic left ventricular pressure all have an important impact on coronary perfusion and could lead to mild ischemia and troponin "leak" [23]. It is also important to realize that troponin elevation does not always indicate cell death and therefore myocardial ischemia is only one of probably many reasons for Tn elevation [24]. Patients should be evaluated with an established risk-score to estimate the probability of CAD, e.g.…”

Section: Discussionmentioning

confidence: 99%

Elevated high-sensitivity troponin does not indicate the presence of coronary artery disease in patients presenting with supraventricular tachycardia

et al. 2017

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With the “Universal Definition,” Measurement of Creatine Kinase-Myocardial Band Rather Than Troponin Allows More Accurate Diagnosis of Periprocedural Necrosis and Infarction After Coronary Intervention

Cited by 130 publications

References 30 publications

Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention

Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention

Frequency of Myocardial Infarction and Its Relationship to Angiographic Collateral Flow in Territories Supplied by Chronically Occluded Coronary Arteries

Elevated high-sensitivity troponin does not indicate the presence of coronary artery disease in patients presenting with supraventricular tachycardia

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