| PrefaceCoronary artery interventional therapy (PCI) is a very important treatment in recent years. Percutaneous transluminal coronary angio-plasty (PTCA) is a main method to treat coronary heart disease (CHD). Coronary artery stenting makes this method safer than before, but it is reported that the incidence of myocardial injury is 40-60%. Cardiac troponin I (cTnl) is a very sensitive and specific marker for cardiac injury determination, von willebrand factor(vWF) is a specific marker for endothelium injury. The aim of the study was to examine the effect of coronary stenting on blood levels of cTnl and vWF and the relationship between cTnl and vWF.MaterialsPatients: The study population consisted of 40 consecutive patients who had coronary angioplasty with stent implantation in our hospital in 2002. Patients who had other diseases and myocardial infarction within 3 weeks were not included in this study. 20 patients who suffered from CHD but only received coronary angiography during the same period were selected as controls. The cardiac function of both groups are below grade two in the NYHA system.Methods1. Catheterization procedureAll patients received Aspirin (0. 3 Q. d p. o. ) Diclipid (0. 25 Bid p. o. ) for 3 consecutive days until the procedure was performed. A 7F sheath was positioned in the right femoral artery. The procedure was performed by standard techniques. Intravenous heparin was routinely administered. All angiograms were reviewed by 2 experienced operators blinded to the results of marker determination. Stents were performed by the same doctor.2. cTnI,vWF measurements4 ml blood samples were collected in tubes right before and 12 hours after the procedure in each patients. All measurements of cTnl were obtained by immumoassay on the beckman access (beckman, A-merican) using specific antibodies raised against cardiac epotopes of troponin I. The upper limit of normal for cTnl is 0. Ing/ml, 5 times a-bove the upper limit is treated as cardiac infarction , 0.1-0.5ng/ml shows tiny cardiac injury in our institution.The other 2 ml blood samples were put in 1/10 0.109mmol/l Sodium Citrate tubes for vWF determination. The normal range is 60 -150%.3. Statistical analysisQuantitative variables are expressed as mean sd. cTnl and vWF were expressed as median due to the skewmess of their distribution. Comparison between groups used the t test for quantitative variables and the chi - square test for qualitative variables. Analysis was performed with SPSS 11. 0 statistical software. P value <0. 05 was considered significant. The null hypothesis was rejected at the 95% confi-dence level.Results1. Baseline characteristicsMean age was 59+9 years in study group and 61+13 in control group. 30 were man in study group and 16 in control groups. The smokers were 16 in study group and 9 in control group. There are 14 cases who had hypertension in study group and 6 in control group. The numbers of hyperlipomia, diabetes mellitus and unstable angina pecto-ris were 17,11 and 24 in study group and 8,5,13 in control group respectively. There was no significant difference in baseline characteristics between two groups.2. Procedure outcomeOverall , the procedure was successful in 40 patients (100% ). We implanted 53 stents in the coronary artery and performed PTCA for 57 arteries. All the patient did not suffer from acute myocardial infarction.3. cTnl and vWF determination 3. 1 cTnlIn study group, cTnI elevation was seen in 6 patients who were all unstable angina pectoris. 8 patients had cTnI elevation after the procedure. The total number was 14 (35%) with cTnI elevation. Mean cTnI level before and after procedure were 0.050+0.049ng/ml and 0.098+0.108ng/ml. In the study group, the blood levels of cT-nI after the procedure were significantly higher than those before the procedure.In control group, cTnl elevation was seen in 3 patients before and after the procedure. Other 17 patients had normal cTnI. Mean cTnIlevels were 0.055+0.056ng/ml and 0.058... |
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