Elevated Troponin after Heart Stents. Long Term Effects??

[MaryRoe]

Happy New Year.

I had a Heart Cath/Stents, 3 weeks ago. Previously, I had the same in August/2004

The first cath/stent in RCA and LAD, I felt GREAT!

The latter,3 weeks ago, I did not do well. He stented a 50% and 40% blockage in RCA. Was told the pressure readings indicated this.

Admitted overnight and felt like a weight on my chest and back. Dismissed the next morning. No meds.

Two days later went to ER room. The Troponin level was elevated (0.54) and potassium decreased. (other enzymes were normal)

ER doctor said 12 hours after stenting, the Troponin had to of been a lot higher and now on its way down. He wanted to admit me but cardio doc on call told him to release me as high Troponin must be due to recent stents.

I found during the first heart cath in August,the hospital took enzyme levels,Pre-op and post op. All normal.

They did not do blood pre-heart cath, 3 weeks ago. An aid tried to get blood the next morning after the latter cath/stents but could not find a good vein. Had I known the seriousness of getting enzymes levels, post stenting, I would of ask for someone to find a vein. I was released.

I am sick something happened in the last stenting in RCA with high Trop seen 2 days later in ER.

Cardio doc said injury must of incurred and happens in 10% of patients and brushed it aside.

Doctor, have you seen this and could you comment on this? What is my prognosis? Should I be followed closely with various tests and blood enzymes?  I have great insurance.Female in my 50's and concerned. I do not want a sudden event. Thanks,doctor.

[MaryRoe]

I am sorry to hear about your Dad. He needs a lot of support to kick the habit and to bring his Lipids down.

His doctor should be able to help with a Smoke Cessation program and trials of statins for his cholesterol.  I know my GP never believed in statins and wanted his patients to diet and exercise..yada yada yada.  It was not until I had the Heart Cath and a 99% blockage discovered with "old" scarring seen, did I try Crestor after trying Lipitor, Zorcor and Pravachol samples. Samples of various statins are available at most doctor's offices. Crestor is helping me now.

Many doctors do not want a patient to ask a lot of questions.  Pesty, they call us  (-:  They do not want to be challenged as they are too busy.

Last night I did e-mail the heart Cath/Stent doctor I was referred to 3 weeks ago, with questions as to "what happened in the Cath Lab, where are my Enzyme/Triponin numbers before I was discharged" and what can I do now to be a "low risk heart patient"?

I hate to have to do this. I love things to flow smoothly but heart disease is no brush off matter and we all need to take charge.  "No one loves you as much as you love yourself"....One's body is a Precious and Priceless commodity.

Wishing the best to you and your Dad in 2005.

[MaryRoe]

I am sorry to hear about your Dad. He needs a lot of support to kick the habit and to bring his Lipids down.

His doctor should be able to help with a Smoke Cessation program and trials of statins for his cholesterol.  I know my GP never believed in statins and wanted his patients to diet and exercise..yada yada yada.  It was not until I had the Heart Cath and a 99% blockage discovered with "old" scarring seen, did I try Crestor after trying Lipitor, Zorcor and Pravachol samples. Samples of various statins are available at most doctor's offices. Crestor is helping me now.

Many doctors do not want a patient to ask a lot of questions.  Pesty, they call us  (-:  They do not want to be challenged as they are too busy.

Last night I did e-mail the heart Cath/Stent doctor I was referred to 3 weeks ago, with questions as to "what happened in the Cath Lab, where are my Enzyme/Triponin numbers before I was discharged" and what can I do now to be a "low risk heart patient"?

I hate to have to do this. I love things to flow smoothly but heart disease is no brush off matter and we all need to take charge.  "No one loves you as much as you love yourself"....One's body is a Precious and Priceless commodity.

Wishing the best to you and your Dad in 2005.

[MaryRoe]

Good morning.

First off the hospital made a boo boo in NOT taking Enzyme levels while I was there 3 weeks ago for my second heart cath/stents. In August they did and I have those copies and all Enzymes, incl. Troponin were well below normal pre/post heart cath and stents.

I did not go to a fly by night hospital. This heart center is listed as a top notch place. )-:   I will not retun to this center.

We have nothing to compare the elvated Troponin taken 3 days post stent in the ER room  as none were taken when I was complaining of chest and back discomfort after the heart cath/stents in the hospital.  

I did ask for another Troponin 2 days after the ER room elevation (5 days after the stents)and it had come down to 0.2.  Normal ranges for Troponin are (0.00 - 0.15)

Even though the CPK and CK-MB and BNP were all normal in the ER room, articles list Troponin levels are more indicitive of a
cardiac event or death within a 7 month period.  Scary to say the least.

Happy New Year to you also and best of Luck.

[Erik36]

CRP is C Reactive Protein. It is present in the blood in higher concentrations when there is an inflamation process in the body like Coronary Artery Disease. It is used as a predictor of future Coronary events. However, CRP alone isn't predictive of Coronary events, it is just one piece of the puzzle including Lipids, Family history, blood pressure, diet, exercise and age.

[Inthava]

What is CRP?

[MaryRoe]

Thank You so much.  I feel better.

After being on Crestor for 6 weeks back in September, my cholesterol for the first time ever was 180,  LDL 87, HDL49 and tryglercides 140. All the other statins I tried I could not tolerate.  These good numbers were reached with only 5mg of Crestor.  Hubby's cholesterol was thru the roof and none of the other statins did much for him.  Crestor has at 10mg.  I am not advocating Crestor but this is the only statin that has helped us and no side effects.

I will get back into cardiac rehab next week. Took 3 weeks off  during this scare. I am on Topol XL50mg. Plavix for another year and Avalide 150/12.5. and 2 81mg. aspirin, daily.

I will call my Cardiologist on Monday.

On a happier note...Texas beat Michigan (-: in the Rose Bowl.

Thanks again, Doctor and May Your New Year be happy.

[Cleveland Clinic]

Elevations of enzymes after intervention is common, so I wouldnt exactly say it is not normal.  Unfortunately, there isnt going to be an exact explanation of what may have happend to cause the elevatuon as there are many potential causes. Sometimes, there is a very small amount of myocardial injury that happens during stent inflation, or a small amount of thrombus that can lead to the minor elevations of troponin or CK-MB.  

Because there is alot of debate of the meaning of elevations of troponins after intevention, you should focus on the markers we know can have impact on your future course.  If your lipids are under good control and your CRP is low, you will be in the lowest possible risk group for future events using data that has been tested in large populations.

good luck

[MaryRoe]

Dear Doctor,

Thanks for commenting on my question.  I hate to bother you again.

You mentioned a 3-5 times increase of Troponin levels could be in the danger zone of a future event but said I was not in that area.

My first Cath in August the Troponin levels being normal under <o.15. pre and post stenting.  3 days after the last cath my troponin level was elevated at 0.54. I do not have any Troponin numbers 6-12 hours immediatley after the stents as the hospital could not or did not get blood. Wouldn't the troponin level soon after the stents be higher than the 0.54 number seen 3 days later?  Could you give me a range that is 3-5 times higher?  Where does 0.54 fit in this range?

Needless to say, I have been scard out of my wits over this and the docs have addressed this as light.  I had a feeling that this is not a normal phenonomen.

Thanks so much, doctor.  I am raising grandchildren and they need me.

P.S. Is there a specialist in the country that has expertise in elevated trop levels after stenting to help weed out what happened to me.

[MaryRoe]

I forgot to add that a follow up Echocardiogram one week after the recent heart caths..showed a E fraction of 66%.  Does an Echo show a heart attack occuring from stenting?

Thanks again.

[Cleveland Clinic]

Mary,

Thanks for the post.

Its difficult to say exactly what happened without being able to review all of your data during your event.  

However, we do see elevated cardiac enzymes after percutaneous stenting.  There has been alot of debate on the overall significance, but a significant rise (3-5 fold increase over the normal levels) of either CK-MB or Troponin are thought to be predictive future events.

I approach those with elevations in enzymes as patients that need to be on maximal therapy to ensure that known risk factors such as cholesterol and CRP are kept as low as possible with intensive statin therapy, antiplatelet herapy and aggressive lifestyle modifications to include diet, exercise and weight control.

Your enzymes were lower then the 3-5 fold level so they dont have much role in determining a long term prognosis. As I mentioned, you should have routine evaluation of CRP and lipid levels and otherwise work with your doctor to develop the lifestyle mnodifications I mentioned.

An echo will often show if there is complete occlusion of an artery and if the stent were to be completely closed.  However, if an area of the heart wasnt getting enough blood, then it should show an abnormality on the echo.

Good luck!