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Cardiac <t>biomarker</t> release in a patient undergoing uncomplicated bifurcation percutaneous transluminal coronary intervention for unstable angina. This case clearly demonstrates the importance of specifying exactly when a proposed cTn decision limit should be used to diagnose peri-interventional AMI after elective PCI. A 55-year-old male with a history of CAD was admitted with symptoms of unstable angina. He underwent PCI of the left circumflex coronary artery 11 years ago. Serial ECGs before and after PCI showed no signs of acute myocardial ischemia. Serial hs-cTnT testing in the emergency department before PCI revealed concentrations within the normal range without a significant change. The criteria for AMI were not met. Urgent coronary angiography revealed a subtotal in-stent restenosis at the distal end of the stent involving the distal circumflex artery bifurcation (see ( A ), marked with a circle). There was no other significant stenosis. PCI was performed with an excellent primary result without any complications (see ( B ), marked with circle). The biomarker time courses are listed in ( C ). hs-cTnT showed no significant increase within 4 h after PCI, but increased significantly above the upper reference limit of 14 ng/L the following morning. Creatine kinase activities remained within the reference limit even showing a constant decline; the patient was a tunnel-building construction worker with physically demanding work. Abbreviations: high-sensitivity troponin T (hs-cTnT), percutaneous coronary intervention (PCI), circumflex artery (RCX), coronary artery disease (CAD), acute myocardial infarction (AMI).
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Cardiac biomarker release in a patient undergoing uncomplicated bifurcation percutaneous transluminal coronary intervention for unstable angina. This case clearly demonstrates the importance of specifying exactly when a proposed cTn decision limit should be used to diagnose peri-interventional AMI after elective PCI. A 55-year-old male with a history of CAD was admitted with symptoms of unstable angina. He underwent PCI of the left circumflex coronary artery 11 years ago. Serial ECGs before and after PCI showed no signs of acute myocardial ischemia. Serial hs-cTnT testing in the emergency department before PCI revealed concentrations within the normal range without a significant change. The criteria for AMI were not met. Urgent coronary angiography revealed a subtotal in-stent restenosis at the distal end of the stent involving the distal circumflex artery bifurcation (see ( A ), marked with a circle). There was no other significant stenosis. PCI was performed with an excellent primary result without any complications (see ( B ), marked with circle). The biomarker time courses are listed in ( C ). hs-cTnT showed no significant increase within 4 h after PCI, but increased significantly above the upper reference limit of 14 ng/L the following morning. Creatine kinase activities remained within the reference limit even showing a constant decline; the patient was a tunnel-building construction worker with physically demanding work. Abbreviations: high-sensitivity troponin T (hs-cTnT), percutaneous coronary intervention (PCI), circumflex artery (RCX), coronary artery disease (CAD), acute myocardial infarction (AMI).

Journal: Journal of Clinical Medicine

Article Title: The Pathophysiology of Cardiac Troponin Release and the Various Circulating Cardiac Troponin Forms—Potential Clinical Implications

doi: 10.3390/jcm14124241

Figure Lengend Snippet: Cardiac biomarker release in a patient undergoing uncomplicated bifurcation percutaneous transluminal coronary intervention for unstable angina. This case clearly demonstrates the importance of specifying exactly when a proposed cTn decision limit should be used to diagnose peri-interventional AMI after elective PCI. A 55-year-old male with a history of CAD was admitted with symptoms of unstable angina. He underwent PCI of the left circumflex coronary artery 11 years ago. Serial ECGs before and after PCI showed no signs of acute myocardial ischemia. Serial hs-cTnT testing in the emergency department before PCI revealed concentrations within the normal range without a significant change. The criteria for AMI were not met. Urgent coronary angiography revealed a subtotal in-stent restenosis at the distal end of the stent involving the distal circumflex artery bifurcation (see ( A ), marked with a circle). There was no other significant stenosis. PCI was performed with an excellent primary result without any complications (see ( B ), marked with circle). The biomarker time courses are listed in ( C ). hs-cTnT showed no significant increase within 4 h after PCI, but increased significantly above the upper reference limit of 14 ng/L the following morning. Creatine kinase activities remained within the reference limit even showing a constant decline; the patient was a tunnel-building construction worker with physically demanding work. Abbreviations: high-sensitivity troponin T (hs-cTnT), percutaneous coronary intervention (PCI), circumflex artery (RCX), coronary artery disease (CAD), acute myocardial infarction (AMI).

Article Snippet: The author reports research collaboration on cardiac biomarker point-of-care diagnostics with Siemens Healthineers, The Netherlands.

Techniques: Biomarker Discovery