Validity of Cardiac Markers as Diagnostic and Prognostic Indicators of Complications in Patients undergoing Percutaneous Coronary Intervention

Abstract

Objectives: The aim of this study was to assess the diagnostic and prognostic value of heart-type fatty acid-binding protein (H-FABP) in elective percutaneous coronary intervention (PCI) and compare it with standard cardiac markers.

Methods: A prospective evaluation was done of 80 consecutive patients admitted for elective PCI. Serum cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase-MB (CK-MB mass), myoglobin, and H-FABP were determined pre-angioplasty and 1, 2, 4, and 16-24 hrs post-angioplasty. Elevated cardiac markers were correlated with demographic, angiographic and procedural variables. Patients were followed up for 20-26 months.

Results: H-FABP peaked early at 2 hours and was useful for the early detection of evolving AMI within 1-3 hours after angioplasty. Cardiac-TnI, myoglobin, H-FABP, CK-MB mass, and cTnT concentrations were elevated in 46.25%, 17.5%, 13.3%, 11.25%, and 7.5% respectively. Cardiac-TnI was the most sensitive marker for detecting all complications and was superior to all other markers. Elevated cardiac markers were correlated with old age (P < 0.02); chest pain ± ECG changes of ischaemia (P < 0.003); use of stents (P < 0.019) and major complications such as major dissection (P < 0.004); transient vessel closure (P < 0.022); bail out stent (P < 0.003), and AMI (P < 0.042). Elevated cardiac markers were associated with a reduction of event-free survival (16.92 versus 20.67 months, P < 0.03).

Conclusion: Heart-type-FABP measurements at 1 hour (or thereafter) post-PCI may offer an early chance of detecting evolving AMI; cTnI was the most sensitive marker for the detection of major complications in patients undergoing PCI. Measurements of cTnI 16-24 hours post-PCI should be part of the routine management of patients following elective PCI.

Keywords: Acute coronary syndrome; Cardiac markers; Cardiac troponins; Complications; Heart-type fatty acid-binding protein; PCI; Percutaneous coronary intervention.

Figure 1

Serum cardiac markers before (0 hour), and at 1, 2, 4, and 16–24 hours after PCI in cTnI positive group. Data are presented as mean ± SD Legend: CK-MB = creatine kinase-muscle and brain mass; cTnI = serum cardiac troponin I; cTnT = serum cardiac troponin T; HFABP = heart-type fatty acid-binding protein

Figure 2

Kaplan-Meier event-free survival analysis for the two groups of patients with cardiac troponin I (cTnI +) and without (cTnI -) elevations during angioplasty. Legend: cTnI = cardiac troponin I