This Article Full Text Full Text (PDF) All Versions of this Article: 110/12/1592    most recent 01.CIR.0000142856.56565.56v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bolognese, L. Articles by Burali, A. Search for Related Content PubMed PubMed Citation Articles by Bolognese, L. Articles by Burali, A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID L-TYROSINE Medline Plus Health Information Angioplasty Cardiomyopathy Related Collections Catheter-based coronary interventions: stents Acute coronary syndromes

(Circulation. 2004;110:1592-1597.)
© 2004 American Heart Association, Inc.

Coronary Heart Disease

Elevations in Troponin I After Percutaneous Coronary Interventions Are Associated With Abnormal Tissue-Level Perfusion in High-Risk Patients With Non–ST-Segment–Elevation Acute Coronary Syndromes

Leonardo Bolognese, MD, FESC; Kenneth Ducci, MD; Paolo Angioli, MD; Giovanni Falsini, MD; Francesco Liistro, MD; Silvia Baldassarre, MD; Antonio Burali, MD

From the Division of Cardiology, S. Donato Hospital, Arezzo, Italy.

Correspondence to Leonardo Bolognese, MD, FESC, Division of Cardiology, S. Donato Hospital, Via P. Nenni n. 22, 52100 Arezzo, Italy. E-mail leonardobolognese{at}hotmail.com

Received April 26, 2004; revision received July 22, 2004; accepted July 29, 2004.

Background— In the setting of non–ST-segment–elevation (NSTE) acute coronary syndromes (ACS), the pathophysiological mechanisms underlying post–percutaneous coronary intervention (PCI) cardiac troponin I (cTnI) elevation remain unclear.

Methods and Results— We evaluated the relationship between troponin elevation and tissue-level perfusion using the TIMI flow grade, corrected TIMI frame count, TIMI myocardial perfusion grade (TMPG), and myocardial contrast enhancement by intracoronary myocardial contrast echocardiography (MCE) before and immediately after PCI performed within 24 to 48 hours of hospital admission in 42 high-risk (angina at rest, unequivocal ST-segment depression, and cTnI elevation) patients with NSTE-ACS. All patients were treated with glycoprotein IIb/IIIa inhibitors (27 with tirofiban and 15 with abciximab) and had successful PCI. Fourteen patients had a postprocedural cTnI elevation, whereas 28 did not. TMPG 0/1 after PCI was observed more frequently in patients with postprocedural cTnI elevation (43% versus 7%; P<0.02). cTnI levels were higher among patients with TMPG 0/1 versus patients with TMPG 2/3 (5.3±2.7 versus 1.5±1.3 ng/mL; P<0.0001). Patients with postprocedural cTnI elevation also presented a significantly lower number of perfused segments at MCE (59% versus 81%; P=0.02) as well as a lower MCE score index (0.65±0.38 versus 0.89±0.21; P<0.02).

Conclusions— Postprocedural cTnI elevation in high-risk patients with NSTE-ACS is associated with an abnormal tissue-level perfusion.

Key Words: acute coronary syndrome • troponin • perfusion • angioplasty

This article has been cited by other articles:

				S. A. Hayat and R. Senior Myocardial contrast echocardiography in ST elevation myocardial infarction: ready for prime time? Eur. Heart J., February 1, 2008; 29(3): 299 - 314. [Abstract] [Full Text] [PDF]

				NACB WRITING GROUP MEMBERS, A. H.B. Wu, A. S. Jaffe, F. S. Apple, R. L. Jesse, G. L. Francis, D. A. Morrow, L. K. Newby, J. Ravkilde, W.H. W. Tang, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Use of Cardiac Troponin and B-Type Natriuretic Peptide or N-Terminal proB-Type Natriuretic Peptide for Etiologies Other than Acute Coronary Syndromes and Heart Failure Clin. Chem., December 1, 2007; 53(12): 2086 - 2096. [Abstract] [Full Text] [PDF]

				J. B. Selvanayagam, A. S.H. Cheng, M. Jerosch-Herold, K. Rahimi, I. Porto, W. van Gaal, K. M. Channon, S. Neubauer, and A. P. Banning Effect of Distal Embolization on Myocardial Perfusion Reserve After Percutaneous Coronary Intervention: A Quantitative Magnetic Resonance Perfusion Study Circulation, September 25, 2007; 116(13): 1458 - 1464. [Abstract] [Full Text] [PDF]

				D. L. Bhatt Shifting the Diagnosis of Periprocedural Myocardial Infarction Upstream Circulation, October 31, 2006; 114(18): 1898 - 1900. [Full Text] [PDF]

				I. Porto, J. B. Selvanayagam, W. J. Van Gaal, F. Prati, A. Cheng, K. Channon, S. Neubauer, and A. P. Banning Plaque Volume and Occurrence and Location of Periprocedural Myocardial Necrosis After Percutaneous Coronary Intervention: Insights From Delayed-Enhancement Magnetic Resonance Imaging, Thrombolysis in Myocardial Infarction Myocardial Perfusion Grade Analysis, and Intravascular Ultrasound Circulation, August 15, 2006; 114(7): 662 - 669. [Abstract] [Full Text] [PDF]

				J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]

				L. Bolognese, G. Falsini, F. Liistro, and P. Angioli Myocardial damage during percutaneous interventions for non-ST-elevation acute coronary syndromes Eur. Heart J. Suppl., October 1, 2005; 7(suppl_K): K15 - K18. [Abstract] [Full Text] [PDF]

				R. P. Giugliano and E. Braunwald The Year in Non--ST-Segment Elevation Acute Coronary Syndromes J. Am. Coll. Cardiol., September 6, 2005; 46(5): 906 - 919. [Full Text] [PDF]