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Fig. 2. Evidence for impaired tissue-level myocardial perfusion by angiography and myocardial contrast echocardiography in patients with elevated levels oftroponin after PCI. TMPG, TIMI myocardial perfusion grade. (Data from ref. 52.)

cTnl Neg cTnl Pos cTnl Neg cTnl Pos

Fig. 2. Evidence for impaired tissue-level myocardial perfusion by angiography and myocardial contrast echocardiography in patients with elevated levels oftroponin after PCI. TMPG, TIMI myocardial perfusion grade. (Data from ref. 52.)

elevation in some studies (10,25). There are no randomized trials comparing the rates of troponin elevation after coronary stenting with those after balloon angioplasty alone.

Association With Inflammation

A recent study showed that the concentration of C-reactive protein (CRP) is frequently increased after PCI, and that elevated CRP is associated with higher rates of troponin elevation (26). This finding suggests that systemic inflammation may be involved in the etiology of periprocedural myonecrosis. This intriguing hypothesis is further supported by a trial demonstrating lower rates of post-PCI troponin elevation in patients who are pre-medicated with atorvastatin, which has been shown to reduce CRP level significantly (27). Alternatively, increases in acute-phase proteins may reflect the inflammatory response to small areas of myonecrosis.

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