Background: High troponin (cTn) levels indicate a poor prognosis of cardiac diseases even in non-acute setting.
Purpose: By measuring pre and post procedural high sensitive (hs) cTnT we aimed to investigate whether diagnostic angiography cause any myocardial injury and also to search the relationship between pre and post angiographic hs cTnT levels and clinical adverse events in patients (pts) with stable coronary artery disease (SCAD) who underwent diagnostic angiography.
Methods: This prospective single blinded study included 253 pts with SCAD in whom myocardial ischemia was shown by noninvasive tests, except in 6%. None of the pts had any disorder that may elevate pre-procedural cTn levels. Coronary angiographies were mainly performed via femoral route. Pre and post-angiographic 4th hour venous blood samples were driven for hs cTnT measurement. A hs cTnT level >14 ng/L (over 99th pecentile) was accepted as elevated. For all pts demographic, clinical and laboratory findings, risk factors and medications were recorded to a data base. Death, acute coronary syndromes, re-vascularization and hospitalization were specified as clinical adverse events and all pts were followed at least for 3 months. For statistical analysis Khi square, Fisher, Mann-Whitney and Kruskal-Wallis tests were used, accordingly.
Results: Advanced age (r=0.157; p=0.012), lower EF (r=-0.212, p=0.002) and higher blood urea levels (r=0.190, p=0.002) were related with pre and post angiographic higher hs cTnT levels. Compared to baseline there was a mean 0.14 ng/L increase in post angiographic cTnT levels. The amount of dye was the only significant parameter related with the post-angiographic elevation of hs cTnT (r=0.127, p=0.044). Although there was a trend of elevation in hs cTnT levels in pts with higher diastolic blood pressure, it did not reach to a significant level (p=0.068). The pts were followed for mean 223±149 days. Clinical adverse events were significantly higher in pts whose pre and post angiographic hs cTnT levels were elevated (p<0.001 for both pre and post procedural levels). By 17.4% coronary re-vascularization was the most common clinical event, followed by hospitalization for cardiac reasons (7,1%) and acute coronary syndromes (1.2%). There was no deaths.
Conclusion: Since the amount of the dye found to be related with the rise of hs cTnT, in order to prevent myocardial injury during diagnostic angiography unnecessary shots should be avoided. Otherwise the procedure is safe in terms of myocardial injury. As shown in other studies in a non-acute clinical setting the high cTn levels predict adverse clinical events.