The Factors And Clinical Significance Of Elevated CK-MB And Hs-cTnT After Elective PCI

OBJECTIVE:Percutaneous coronary intervention(PCI)is an important method for revascularization of coronary heart disease and has been rapidly developed in recent decades.Although interventional techniques are continuously improving,PCI-related myocardial injury is still common.Therefore,it is necessary to study what kind of factors in interventional therapy may cause myocardial inj ury.According to reports in the literature,PCI-related myocardial injury may be due to side-branch occlusion,coronary spasm,intimal tear,and microvascular embolization.The previous studies used to use CK?CK-MB?cTnT,etc to determine the degree of myocardial injury.In recent years,hs-cTnT has been widely used in clinical practice.Its sensitivity is higher than the above indicators,and more and more guidelines recommend hs-cTnT for the diagnosis of acute myocardial infarction.The purpose of this study is to analyze the causes of elevated myocardial troponin T and CK-MB levels after PCI and their predictive value for MACE during hospitalization.METHODS:A total of 120 patients with angina pectoris who underwent elective PCI in our hospital were selected.The patients were asked about their age,gender,hyperlipidemia,past medical history,medication history,and physical examination.During the PCI procedure,the vascular lesions,total number of balloon dilatation,average dilatation pressure,the average dilatation time,the mean diameter of the stent,the TIMI grade of the postoperative main branch blood flow and postoperative side branch blood flow were recorded.Preoperative serum levels of plasma hs-cTnT and CK-MB were collected,and postoperative(16-24h after PCI)plasma levels of hs-cTnT and CK-MB were also collected.Recorded MACE during hospitalization.According to the postoperative level of hs-cTnT patients were divided into significantly elevated group and non-significantly elevated group,and according to the postoperative level of CK-MB patients were divided into elevated group and nomal group.Results:The levels of hs-cTnT and CK-MB increased after PCI,which were significantly different from the preoperative levels.There was a positive correlation between the two levels after operation(R=0.864).Diabetes mellitus,trivessel disease,total number of balloon dilation,and number of postoperative side branch occlusion had statistically significance between hs-cTnT significantly elevated group and hs-cTnT non-significantly elevated group.The factors above also had statistically significance between CK-MB elevated group.and CK-MB.nomal group.Bifurcation lesions and mean length of the stent were only significantly different between hs-cTnT significantly elevated group and hs-cTnT non-significantly elevated group.hs-cTnT significantly elevated group and CK-MB elevated group was more likely to have major adverse cardiac events during hospitalization.The ROC curve was used to analyze the predictive value of the two markers on the patient MACE during hospitalization.The AUC was 0.78 and 0.686 respectively,and the cut-off was 77.6 pg/ml and 3.165 ng/ml respectively.Conclusion:1.Elective PCI may cause elevation of hs-cTnT and CK-MB.2.Diabetes mellitus,three-vessel disease,total number of balloon dilation,and postoperative side branch occlusion are factors influencing the elevation of hs-cTnT and CK-MB after elective PCI.3.Detection of hs-cTnT and CK-MB after elective PCI has certain predictive value for MACE during hospitalization,and Joint detection of two markers predicts more acuracy.