经皮冠状动脉腔内成形术/或支架术后肌钙蛋白I的变化

The change and clinical value of troponin I and endothelin levels following percutaneous transluminal coronary angioplasty and/or stent implantation

目的 探讨经皮冠状动脉腔内成形术(PTCA)和/或支架术后肌钙蛋白I的变化 ,预后意义和相关因素 ,并探讨相应内皮素的变化以及和心肌缺血损伤的关系。方法 监测34例行择期PTCA和/或支架术且术前肌钙蛋白I和肌酸激酶 (CK -MB)正常的患者术后6,12 ,18 ,24h肌钙蛋白I和CK -MB ;术前 ,术后即刻 ,6h ,24h的内皮素水平。观察6～10个月内主要心血管事件的发生。结果 35.30%行择期PTCA和/或支架术且术前肌钙蛋I和CK -MB正常的病例术后肌钙蛋白I升高。6～10个月随访中术后肌钙蛋白I升高组和肌钙蛋白I正常组主要心血管事件发生无显著性差异 ,但肌钙蛋白I升高组中再发心肌缺血均出现在肌钙蛋白I峰值大于该组平均峰值者。多元逻辑回归分析示球囊扩张总时间和不稳定性心绞痛与PTCA和/或支架术后肌钙蛋白I升高有关。术后即刻血浆内皮素升高 ,术后6h升高更明显 ,术后24h恢复到术前水平。结论 PTCA和/或支架术后肌钙蛋白I升高并不少见。术后肌钙蛋白I升高和中期随访中心脏事件发生无明显关系 ,术后肌钙蛋白I较大幅度升高和住院期间再发心肌缺血有关。球囊扩张总时间较长或不稳定性心绞痛易出现PTCA和/或支架术后肌钙蛋I升高。PTCA和/或支架术后内皮素普遍升高 ,术后24h应预防冠脉痉挛。

Objective To explore the change and prognostic value of troponin-I levels following percutaneous transluminal coronary angioplasty(PTCA)and/or stent implantation,and to explore endothelin change and its relation to myocardial ischemia. Methods Troponin-I and MB isoenzyme of creatine kinase(CKMB)levels were monitored6,12,18,24h after procedure while endotheline levels were monitored before procedure,immediately,6h,24h after procedure in34patients who underwent selective PTCA and/or stent implantation with normal troponin-I and CKMB levels before proceˉdures.Major cardiovascular events(death,Q-wave myocardial infarction,revascularization of target vessel and recurrent myocadial ischemia)were recorded in follow-up of6-10months. Results Trponin-I increased following procedure in35.30%of patients who underwent selective PTCA and/or stent implantation with normal troponin-I and CKMB levels before procedures.In follow-up of6-10months,major cardiovascular events occurred in group with increased trponin-I levels as well as in group with normal trponin-I levels without significant difference.But all the recurrent myocadial isˉchemia in group with increased trponin-I levels occurred in the patients with peak trponin-I levels above group average level of peak trponin-I.Total inflation time and unstable angina were associated with trponin-I elevations following PTCA and/or stent implantation.Endothelin increased immediately after procedure,increased more obviously6h after procedure,and changed back to the original level24h after procedure.But there is no significant difˉference of endothelin levels between group of increased troponin-I and normal troponin-I. Conclusion Elevations of troponin-I following PTCA and/or stent implantation are not seldom.Troponin-I elevations following procedure aren't related to major cardiovascular events in intermediate-term folˉlow-up,but troponin-I elevations with greater magnitude may be associated with in-hospital recurrent myocadial ischemia.Patients with longer total infaltion time and unstable angina are prone to have increased troponin-I following PTCA and/or stent implantation.On the other side,PTCA and/or stent implantation is followed by endothelin release,which don't seem to relate to mycardial ischemia or injury.