Estudo observacional dos preditores clínicos e angiograficos de elevação de troponina pós angioplastia

Abstract

BACKGROUND: Troponin T (TnT) and troponin I (TnI) are myocardium necrosis biomarkers very sensible and specific used to evaluate a myocardial injury, and their rise after coronary angioplasty correlate with worst prognoses. Complications associated with this procedure are a well-recognized cause of elevated myocardial necrosis biomarkers. In its absence, though, the exact causes of elevated troponin are merely speculative. OBJECTIVE: This study aims to evaluate the relationship between troponin elevation and clinical and anatomical variables after coronary angioplasty in the absence of complications. METHOD: It is an epidemiological study evaluating 124 patients submitted to coronary angioplasty from January 2019 to December 2019 in the catheter laboratory of University Hospital Francisca Mendes, using clinical variables and troponin doses before, 6 hours and 12 hours after the procedure. This project was submitted and approved by the research ethics committee. RESULTS: Of all 124 analyzed patients, 63,3% were male and mean age of 63 years old. The mean implanted stents per patients was 1,66. Hypertension was the most prevalent comorbidity. Eighty patients (64,5%) presented high troponin dosage (compared to 99th percentile) and 32 (25,8%) showed troponin dosage above five times the 99th percentile. When analyzing all patients presenting troponin dosage above 99th percentile, none of the clinical characteristics were significantly related to troponin alteration. While analyzing procedure-related characteristics, we observed that troponin elevation above 99th percentile is significantly correlate with the number of implanted stents, the number of treated arteries (p<0,001 and p=0,046 respectively), procedure duration (p=0,032), and contrast media volume (p = 0,008). The previous history of smoking was associated with lesser troponin levels in the subgroup of patients with troponin levels above five times the 99th percentile. The number of implanted stents and number of treated arteries were still associated with troponin elevation above five times the 99th percentile. CONCLUSION: Clinical characteristics were not associated with troponin elevation above the 99th percentile. However, the procedure duration, contrast media volume, number of treated arteries, and number of stents implanted are significantly associated with troponin elevation when studying the procedure characteristics. Amongst the subgroup of patients with troponin levels above five times the 99th percentile, the clinical history of smoking, the number of implanted stents and stent length were significantly associated with the elevation of this biomarker above five times the 99th percentile.