[Evaluation of dynamic cardiac troponin I concentrations and C-reactive protein in the monitoring of myocardial infarction in patients with repeated myocardial infarction]

Małgorzata Plak, Leszek Orliński, Marek Łobos, Michał Ciesielczyk, Rafał N Wlazeł, Marek T Paradowski
Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego 2010, 28 (168): 444-9

UNLABELLED: Significant progress in diagnosis and treatment of heart attack led European Society of Cardiology (ESC) and American College of Cardiology (ACC) to develop in 2007 a document on contemporary criteria for diagnosis of fresh myocardial infarction. In the case of percutaneous coronary intervention (PCI) in patients with initially normal serum concentrations of biomarkers troponin increase above the 99th percentile upper limit of the reference points to the occurrence of myocardial necrosis dislodgement. Conventionally assumed that the increased levels of biomarkers of value in excess of 3 x 99th percentile upper reference requires identification of MI in conjunction with PCI.

THE AIM OF THE STUDY: To evaluate the dynamic of troponin concentrations and C-reactive protein in patients with the second or subsequent myocardial infarction undergoing percutaneous coronary intervention (PCI) and comparing the results obtained with the results obtained in patients with first myocardial infarction, in patients undergoing elective coronary angiography and the healthy control group.

MATERIAL AND METHODS: The study involved a total of 120 patients who entered in four groups: study group Z2 and three comparative groups: Z1, the NRA and C. Z2 study group consisted of patients admitted to hospital because of second or subsequent myocardial infarction. Z1 group consisted of patients with first myocardial infarction. Patients groups Z2 and Z1 underwent PCI. The group included people the NRA people with a history of previous myocardial infarction, who underwent elective coronary angiography and after noting the time of surgery of coronary arteries was performed in one PCI slot. Control group C consisted of healthy, free from recognized risk factors for heart attack, in which there were no previous episodes of acute heart. Patients groups Z2 and NRA received statins and ASA before hospitalization. The material in patients with suspected myocardial infarction (study group Z2 and Z1 and in the group NRA represented the blood clot, taken on at the time of notification to the patient to the hospital, between 6 and 9 h, in 16 h, 24 and 48 h hospitalization. In the control group C blood samples were taken at one time. In plasma the concentrations of cardiac troponin I (cTnl), and serum CRP.

RESULTS: The dynamics of median concentrations of cTnl for the test group Z2 and control group Z1 are comparable. Median concentrations are very close to each other (with the exception of point 1) in any of the measuring points, there was no statistically significant differences. Between 6 and 9 time of infarction in group Z1 median concentrations were significantly higher than in Z2. Significant differences were found between the Z1 and Z2 group and the NRA in all. measuring points, at the time of admission, between 6 and 9 time, the 16th, 24th and 48 time of onset of stroke (point 0, p = 0.027, points 1, 2, 3, and 4 p = 0.0000). The reference group of people from the NRA who previously underwent selective coronary heart attack and surgery PCI, 7 patients were observed a slight increase in troponin I concentrations (usually between the 9th and 24th h hospitalisation), not exceeding three times the value of the decision, which permits the exclusion of myocardial. Median concentrations of CRP in 16 h, 24 and 48 h MI showed significant differences between the group and the NRA Z2 (section 2, p = 0.001, section 3 and 4--p < 0.001) and between the group and the NRA Z1 (section 2, p = 0.028, section 3 and 4--p < 0.001). Median values in the group Z2 versus Z1 showed similar dynamics in the time points 0, 1, 2 and 3. Higher median values in the fourth time point were observed in the group Z2. Median CRP at the time of admission to hospital was the highest in the group Z2 (2.65 mg/l), and reference groups Z1 and NRA was 2.25 mg/l and 2.35 mg/l. Median CRP in the groups Z2, Z1 and CRV were significantly higher against the group C (1.20 mg/l). In group C the lowest percentage observed in the results of CRP >3 mg/l (indicating the risk of ACS) of 16.7%. In the other groups this proportion was 30-40% and was highest in the group Z2.

CONCLUSIONS: The concentration of cardiac troponin I in the first hours of the course of myocardial infarction (between 6 and 9 h) in patients who have made a second heart attack tends to lower its growth levels compared to people with first MI. It can be assumed that the myocardial inflammatory response to repeated defense system reduces the area of necrosis and less ejection from the troponin myocardial cells. In patients who underwent myocardial infarction in the past and were subjected to selective coronary angiography, and its treatment by PCI, troponin I, did not exceed three times the 99th percentile of the healthy population, suggesting that the proper emergency procedures cardiac surgeons performing PCI.

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