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Cardiac Troponin After Revascularization Procedures

  • Chapter
Cardiovascular Biomarkers

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

A significant proportion (≈20%) of patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery develop elevated levels of creatine kinase MB isoform (CK-MB) afterward. Large increases in the concentration of CK-MB after PCI are associated with the risk of death, myocardial infarction, and repeat revascularization. However, the prognostic significance of modest elevations (less than five times the upper limit of normal [ULN]) after PCI remains controversial. It has been shown in some studies have shown that even minor elevations in CK or CKMB levels (more than one time the ULN) after PCI are associated with worse outcomes, but other studies have shown no association between small elevations in CK or CK-MB (less than five times the ULN) and recurrent cardiac events. Following CABG, almost all patients have elevated levels of CK-MB and the clinical significance is less well established. However, clinical studies show that large elevations (more than five times ULN) are associated with worse prognosis. Cardiac troponin is elevated more frequently after PCI and CABG. A number of procedure-related factors contribute to the rises in troponin, including unrecognized complications of PCI (distal embolization, minor side-branch occlusion), inflammation, direct cardiac manipulation, and direct current defibrillation during CABG. Although troponin levels are helpful in diagnosing periprocedural myonecrosis as well as predicting long-term outcomes, the optimal diagnostic and prognostic cutoff levels remain to be determined. Moreover, to date, the appropriate clinical response to these findings remains uncertain.

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Authors and Affiliations

  1. Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

    Warren J. Cantor MD (Assistant Professor of Medicine)

  2. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC

    L. Kristin Newby MD, MHS (Associate Professor of Medicine)

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  1. Warren J. Cantor MD
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  2. L. Kristin Newby MD, MHS
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Editors and Affiliations

  1. Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

    David A. Morrow MD, MPH

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© 2006 Humana Press Inc., Totowa, NJ

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Cantor, W.J., Newby, L.K. (2006). Cardiac Troponin After Revascularization Procedures. In: Morrow, D.A. (eds) Cardiovascular Biomarkers. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-051-5_7

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