Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019, 163(4):324-330 | DOI: 10.5507/bp.2018.066

Selective coronary angiography, percutaneous coronary intervention and asymptomatic peri-procedural myocardial injury

Martin Grivaa,e, Jiri Stastnya, Petr Koprivaa, Martin Slabaka, Zdenek Coufala, Jiri Jarkovskyb, Michal Svobodab, Tomas Salekc, Lucie Sukupovad, Milos Taborskye
a Cardiovascular Center for Adults, Tomas Bata Regional Hospital, Zlin, Czech Republic
b Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
c Department of Clinical Biochemistry, Tomas Bata Regional Hospital, Zlin, Czech Republic
d Department of the Director, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
e Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic

Background: While there have been a number of studies reporting the incidence and implications of elevated troponin levels after percutaneous coronary intervention (PCI), the body of information about the incidence, associations, and implications of elevated troponin levels following coronary angiography (CAG) is limited.

Materials and Methods: A total of 220 consecutive patients with stable coronary artery disease or intermediate or low-risk acute coronary syndrome without persistent ST-segment elevation (NSTE-ACS) were included in our study. High-sensitivity cardiac troponin I (hs-cTnI) levels were measured before and after coronary angiography (CAG) in patients with or without PCI and correlated with a number of clinical variables.

Results: Hs-cTnI elevations above the 99th percentile upper reference limit (URL), or above 20% of the initially positive, yet already declining values, were found in 60 (37.2%) patients after CAG and in 45 (76.2%) patients undergoing PCI. Significant correlations of hs-cTnI elevation were found with the following variables: volume of contrast, fluoroscopy time, dose-area product, amount of contrast agent injected directly into the coronary arteries, total time of balloon dilation and the number and total length of implanted stents (P<0.001 for all).

Conclusion: While an asymptomatic elevation of hs-cTnI is a common finding after PCI, it does occur, quite surprisingly, also after CAG. Despite contradictory views regarding the clinical relevance of asymptomatic post-procedural elevated hs-cTnI levels, it is generally believed that a mild elevation is not associated with an increased risk. Still, it may pose a diagnostic quandary following a successful interventional procedure and even more so after an uncomplicated CAG. Trial Registration: Clinicaltrials.gov - NCT02960321

Keywords: coronary angiography, percutaneous coronary intervention, high-sensitivity troponin, periprocedural myocardial injury

Received: July 22, 2018; Accepted: October 15, 2018; Prepublished online: November 6, 2018; Published: December 11, 2019  Show citation

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Griva, M., Stastny, J., Kopriva, P., Slabak, M., Coufal, Z., Jarkovsky, J., ... Taborsky, M. (2019). Selective coronary angiography, percutaneous coronary intervention and asymptomatic peri-procedural myocardial injury. Biomedical papers, 163(4), 324-330. doi: 10.5507/bp.2018.066
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