经皮冠状动脉腔内成形术后血清肌钙蛋白I的变化及意义的研究(摘要)

Objective: Percutaneous transluminal coronary angioplasty (PTCA) has become the most popular invasive procedure for myocardial revascularization Insistant cheat pain is a main symptom for some patitnets after coronary balloon dilatation or stenting To study the myocardial damage during PTCA We examined the relations of elevated cardial troponin I (cTnI), MB isoenzyme of creatime kinase (CK MB) activity and the change of electrocardiolgram (ECG) before, during and after PTCA Methods: In 57 consecutive patients undergoing non emergency PTCA and 6 patients undergoing emergency PTCA the cTnI and CK MB activity were measured before and 6, 10, 24 and 48 hours after procedure, and the ECG was taken simultaneously Results: Ten patients (17 54%, 10/57) in non emergency PTCA group and 3 patients (50%, 3/6) in emergency PTCA group had remaining angina after PTCA Most patients with remaining angina were associated with procedure complications (intimal dissection, coronary embolization and side branch occlusion, 61 5%, 8/13) and with residueal stenosis (46 2%, 6/13) A significent increase of cTnI and CK MB was seen in 2 patients non emergency PTCA group Among the subgroup, 2 occured coronary occlusion, 1 D 1 occlusion induced by PTCA The increased levels of cTnI were significantly correlated with the total baloon inflation time ( p <0 05) 20 patients had minor myocardial damage (MMD) with slightly elevated cTnI but without increase of CK MB activity In 6 patients, their T wave was reversed in V 4 6 after RCA dilatation or stenting and remained the increase for 48 hours Although their RCA was reopened and coronary flow recovered to TIMI 3 In 6 cases the collateral circulation from left to right coronary disappeared Conclusions: Our study showed that the patients with remaining angina often have cTnI increasing after PTCA The reasons are the abrupt occlusion, distal coronary folw obstruction (including collateral circulation disappearing) intimal dissection and side branch occlusion cTnI measurement may be beneficial for assessing the degree of myocardial damage So cTnI level is a sensitive marker for evaluating coronary flow recovery and myocardial ischemia after PTCA