Frequency and prognostic value of cardiac troponin I elevation after coronary stenting

Mild myocardial injuries after coronary angioplasty are associated with adv erse late outcomes. The incidence and prognostic value of this phenomenon w hen using cardiac troponin I (cTnl) after stent implantation is unknown. We studied cTnl and creatine kinase (CK) release in 109 patients after stenti ng. Clinical success was achieved in 103 patients (94%). In-hospital major adverse coronary events were: death in 1 patient, Q-wave myocardial infarct ion in 1 patient, and non-Q-wave myocardial infarction in 2 patients. Twent y-nine patients (27%) had postprocedural cTnl increase, 16 (15%) had CK ele vation. No preprocedural variables predicted marker elevation. Marker relea se was related to the occurrence of in-lab complications (59% vs 29% [p = 0 .004 for cTnl] and 69% vs 32% [p = 0.011 for CK]). In 34% no explanation wa s found for cTnl increase. Success was more frequent in patients without cT nl elevation (100% vs 86%, p <0.001). The negative predictive value of cTnl increase was 100% for in-hospital major adverse coronary events (MACE), wh ereas its positive predictive value was 14%. cTnl and CK concordant elevati on was associated with more intra- and postprocedural adverse events. Durin g a mean follow-up of 8 +/- 3 months, major adverse coronary events were: d eath in 2 patients, myocardial infarction in 2 patients,and repeat PTCA in 8 patients. cTnl elevation was not predictive of these late MACE. cTnl elev ation is common after stenting, and is related to the occurrence of in-lab complications. Its isolated elevation is not a good predictor of MACE. Pati ents with concordant cTnl and CK elevation seem to be at higher risk of in- hospital MACE. (C) 1999 by Excerpta Medico, Inc.