Can I submit a case report to an anesthesia journal about a patient who previously underwent percutaneous coronary intervention (PCI) and now has elevated troponin I?

Can You Submit This Case to an Anesthesia Journal?

Yes, you can absolutely submit a case report about a post-PCI patient with elevated troponin I to an anesthesia journal, as this represents a clinically relevant perioperative scenario that anesthesiologists frequently encounter.

Why This Case Has Merit for Publication

Clinical Relevance to Anesthesia Practice

• Troponin elevation after PCI is extremely common, occurring in 13.6-48% of patients depending on the assay and threshold used 1.
• Troponin I typically returns to normal within 5-14 days after uncomplicated PCI, with normalization expected by 2 months post-procedure 2.
• If your patient presents with elevated troponin I at a time point when it should have normalized, this suggests either ongoing myocardial injury, a new acute coronary event, or a complication requiring perioperative risk stratification 2.

What Makes Your Case Publishable

The key question is the timing and magnitude of the troponin elevation relative to the PCI:

• If troponin is elevated weeks to months after PCI (when it should be normal), this warrants investigation for new ACS, stent thrombosis, restenosis, or non-cardiac causes of troponin elevation 2.
• If the patient requires anesthesia/surgery with persistently elevated troponin, this creates a high-risk perioperative scenario that anesthesiologists must manage 2.
• Any troponin elevation >5× the upper reference limit (URL) after PCI is associated with increased risk of major adverse cardiac events, including higher rates of death and repeat revascularization 1, 3.

Specific Elements That Strengthen Your Case Report

Document These Clinical Details

• Timing of troponin measurement relative to the index PCI procedure (hours, days, weeks, or months) 4.
• Baseline pre-PCI troponin level versus post-PCI peak and current values—troponin must be measured both before and after PCI to accurately diagnose procedure-related injury 4.
• Magnitude of elevation: Minor elevations (<3× URL) have uncertain prognostic significance, while elevations >5× URL predict adverse outcomes 1, 5, 3.
• Clinical context: Presence or absence of chest pain, ECG changes, hemodynamic instability, or echocardiographic wall motion abnormalities 2, 6.

Anesthesia-Specific Angles to Emphasize

• Perioperative risk stratification in a patient with recent PCI and elevated biomarkers.
• Timing of elective surgery after PCI—guidelines recommend delaying elective procedures, but emergent cases create management dilemmas.
• Antiplatelet therapy management—balancing bleeding risk versus stent thrombosis risk in the perioperative period 1, 6.
• Anesthetic technique selection and hemodynamic goals in a patient with ongoing myocardial injury.

Common Pitfalls to Avoid in Your Case Report

Do Not Misinterpret Troponin Elevation

• Isolated troponin elevation without clinical or procedural complications may not be clinically significant, particularly if <5× URL 7, 8.
• A 2022 study of 673 patients undergoing left main PCI found that troponin elevation (even >5× URL) was not associated with adverse long-term outcomes when it occurred in isolation without other complications 7.
• Troponin elevation is expected immediately post-PCI in 28.7-61.5% of patients and does not necessarily indicate MI unless accompanied by symptoms, ECG changes, or imaging abnormalities 5, 8.

Consider Non-Coronary Causes

• Renal dysfunction causes chronic low-level troponin elevation due to decreased clearance 2.
• Heart failure, pulmonary embolism, sepsis, and other non-ACS conditions can elevate troponin 2.
• Do not assume elevated troponin automatically equals new MI—the clinical context determines significance 2.

Address Antiplatelet Therapy Status

• Document whether the patient is on dual antiplatelet therapy (DAPT) and the duration since PCI 1, 6.
• DAPT should continue for at least 12 months after PCI regardless of stent type 6.
• Premature discontinuation of DAPT increases stent thrombosis risk, which could explain persistent troponin elevation 6.

How to Frame Your Case for Maximum Impact

Structure Your Case Report Around These Questions

1. What was the indication for the index PCI? (STEMI, NSTEMI, unstable angina, stable CAD) 1, 6.
2. What is the time interval between PCI and troponin measurement? (This determines whether elevation is expected or pathologic) 2, 4.
3. What is the magnitude of troponin elevation? (Use multiples of the 99th percentile URL) 1.
4. Are there clinical signs of ongoing ischemia? (Chest pain, ECG changes, wall motion abnormalities) 2, 6.
5. What was the anesthetic management strategy? (Risk stratification, monitoring, hemodynamic goals, antiplatelet management).
6. What was the outcome? (Perioperative complications, need for revascularization, long-term follow-up).

Emphasize the Anesthesia Learning Points

• How you risk-stratified the patient using troponin trends, ECG, echocardiography, and functional capacity 2, 6.
• How you balanced antiplatelet therapy against surgical bleeding risk 1, 6.
• How you optimized hemodynamics to minimize myocardial oxygen demand in a patient with ongoing injury 6.
• How you monitored for perioperative cardiac events (continuous ECG, serial troponins, echocardiography) 1.

Your case is publishable if it demonstrates a unique clinical challenge, an unexpected complication, a novel management approach, or an educational lesson for anesthesiologists managing post-PCI patients with elevated troponin.