Avaliação comparativa do valor prognóstico de quatro marcadores bioquímicos de lesão miocárdica pós intervenções percutâneas utilizando stents coronarianos

Abstract

Objective To assess the prognostic effect of the changes in the levels of 4 biochemical markers of myocardial damage (CK-MB activity/ mass and troponins T and I) after stent implantation in regard to the occurrence of death, infarction, and new myocardial re- vascularization procedures in a one-year period. The study also aimed at determining the incidence of their elevations and the existence of predictive variables. Methods Those 4 markers were measured in 199 patients treated with stent implantation in native arteries in the following 3 pe- riods: before the procedure, 6-8 hours after the procedure, and 14-18 hours after the procedure. Survival curves and Cox logistic regression were used to determine the prognostic impact of the changes on the occurrence of cardiac events in one year. Results Changes in the levels of the 4 markers after stent implantation are relatively frequent (6.1% to 32.8%), are associated with the degree of complexity of the lesions treated (long lesions and angulations > 45o) and with the development of problems during the procedure (occlusion of the secondary branches, presence of angina, and electrocardiographic changes). The infarction- free survival rate and the need for a new revascularization were significantly lower only in the patients with an elevation in the CK-MB activity after the procedure as compared with those in patients without that alteration (60% x 85.08%; P=0.025). The following variables influenced the event-free survival rate: diabetes mellitus (OR: 2.27; P=0.0256), balloon predilation (OR: 3.16; P=0.0082), and an elevation in the CK-MB activity after the procedure (OR: 3.64; P=0.0162).