Abstract 2684: Is Troponin I Elevation an Exclusion Criteria for Secondary Prevention Implantable Cardioverter-Defibrillator Implantation?
Ventricular tachyarrhythmias (VT/VF) due to a transient or reversible disorder are class 3 indications for ICD. VT/VF during acute coronary syndrome defined by a troponin I (TNI) elevation and ST elevation are class 3 indications. But how to manage patients with TNI elevations without ST and T wave modifications after VT/VF ?
Methods: We prospectively followed during 1 year, 107 patients implanted with ICD after VT/VF on cardiomyopathies. Patients with a normal structural heart disease or right ventricular disease were excluded. When TNI increased after the index event, ECG modifications indicating acute coronary syndrome and recent coronary event disclosed by coronary angiography were exclusion criteria for ICD implantation. Coronary stenosis and old coronary occlusion were not exclusion criteria for ICD implantation. TNI was normal if ≤ .5pg/ml.
Results: Patients’ characteristics in function of TNI level are summarized in table 1⇓. TNI elevations occurred in 61 (57%) pts with a mean TNI level of 3.26 ± 5.69 and a maximum value of 32.4 pg/ml. In 36 (33.6%) pts the TNI elevation was > at 5 fold the normal value (> 2.5 pg/ml). TNI elevations occurred in 14 patients with non ischemic cardiomyopathies. At 1 year FU appropriate ICD therapies were delivered in 50% of the population. The TNI levels after index even were 2.4±3.3 and 4.1±7.2 pg/ml in patients without and with therapies during FU respectively (ns). TNI level did not influenced therapies occurrences (table 1⇓).
Conclusion: TNI elevation, even if elevation was > at 5 fold the normal value, without ECG modifications should not be an exclusion criteria for secondary prevention ICD implantation.