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
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
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DOI：
10.1161/01.cir.0000142856.56565.56
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发表时间：
2004-09-21
期刊：
影响因子：
37.8
通讯作者：
Burali, A
中科院分区：
文献类型：
--
作者：
Bolognese, L;Ducci, K;Burali, A
背景-在非ST段抬高（NSTE）急性冠状动脉综合征（ACS）的情况下，经皮冠状动脉介入治疗（PCI）后心肌肌钙蛋白I（cTnI）升高的病理生理机制仍不清楚。方法和结果-我们使用TIMI血流分级、校正的TIMI帧数、在42例高危NSTE-ACS患者（静息心绞痛、明确ST段压低和cTnI升高）中，在入院24 - 48小时内进行PCI术前和术后即刻进行TIMI心肌灌注分级（TMPG）和冠状动脉内心肌造影超声心动图（MCE）心肌造影增强。所有患者均接受糖蛋白IIb/IIIa抑制剂治疗（27例使用替罗非班，15例使用阿昔单抗），并成功进行PCI。14例患者术后cTnI升高，28例未升高。在术后cTnI升高的患者中，PCI后TMPG 0/1的出现率更高（43%比7%; P < 0.02）。TMPG 0/1患者的cTnI水平高于TMPG 2/3患者（5.3 +/- 2.7 vs 1.5 +/- 1.3 ng/mL; P < 0.0001）。术后cTnI升高的患者在MCE时的灌注节段数量也显著减少（59% vs 81%; P = 0.02）以及较低的MCE评分指数（0.65 +/- 0.38对比0.89 +/- 0.21;结论：高危NSTE-ACS患者术后cTnI升高与组织水平灌注异常相关。
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.