Analysis Of Clinical Characteristics And Influencing Factors Of Troponin Elevation After Elective Percutaneous Coronary Intervention

BackgroundsPerioperative troponin elevation is very common in patients with elective PCI,and the clinical prognosis of patients with perioperative myocardial injury and myocardial infarction is different,but there are few studies on the clinical characteristics and influencing factors of patients with myocardial injury and myocardial infarction.This study is a single center,retrospective study.The purpose of this study is to observe the clinical characteristics of troponin elevation in patients with coronary heart disease after percutaneous coronary intervention,to analyze the differences between perioperative myocardial injury and myocardial infarction,and to analyze the influencing factors of troponin elevation in elective PCI patients according to clinical findings.It is expected to improve the understanding of perioperative myocardial injury and type 4a myocardial infarction in patients with elective PCI,and provide theoretical basis for further improving the prognosis of patients with coronary heart disease.MethodsA total of 201 patients with angina pectoris treated in the Department of Cardiology,Xiangya second Hospital of Central South University from December 2020 to December 2021 were collected.110 patients in the admission group were selected according to the inclusion and exclusion criteria.Collect clinical baseline data,laboratory examination and PCI surgical treatment.According to the increase of troponin and the evidence of ischemia after operation,the patients were divided into two groups: myocardial injury group(n = 75)and type 4a myocardial infarction group(n = 35).By comparing and analyzing the clinical baseline data,drug use,laboratory indexes and surgical data between the two groups,the clinical characteristics were described and the risk factors of perioperative troponin elevation were discussed.According to the clinical symptoms before admission,the patients were divided into stable angina pectoris group(n = 22)and unstable angina pectoris group(n = 88).According to the intraoperative SYNTAX score,the patients were divided into different SYNTAX intervals.The differences of indexes among the groups were analyzed,and the clinical characteristics and risk factors were discussed.Results1.Most of the postoperative troponin elevation in patients with elective PCI in our center was mild myocardial injury,accounting for68.2% of 31.8% of patients with 4a MI;of which 80.0% were unstable angina(UA)and 20.0% were stable angina(UA).2.In patients with type 4a MI,the number of patients with unstable angina pectoris is higher than that of myocardial injury,accounting for94.3%.3.There was no significant difference in the length and number of stents implanted during the operation,the location of the lesion(proximal,middle and distal)and chronic complete occlusive disease(Chronic total occlusion CTO)between patients with myocardial injury and type 4a MI,but myocardial injury was more common when SYNTAX score ≤ 22,and myocardial infarction was more common when the score was 22-32.4.The average hospital stay of patients with UA before operation was longer than that of patients with SA,and the frequency of using low molecular weight heparin was higher and the level of hemoglobin was lower.In UA group,the level of high sensitivity troponin(high-sensitive troponin THs-c TnT)was higher than that of SA before operation,and the difference was more obvious after operation.5.For the patients with cardiac troponin elevation before UA after elective PCI,the higher the SYNTAX score,the longer the hospital stay,the longer the number and length of stents,and the more patients with postoperative Hs-c TnT > 8 times.6.For patients with elevated TnT after elective PCI,the higher the SYNTAX score,the higher the postoperative troponin level and the more patients with type 4a myocardial infarction.Conclusions1.The increase of troponin after elective PCI is mostly myocardial injury.2.Patients with unstable angina pectoris are more likely to have type4 a myocardial infarction.3.SYNTAX score is a tool to predict the degree of myocardial injury after PCI in patients with coronary heart disease.Its predictive value is higher in patients with unstable angina pectoris.