# Stage 6 — Evaluate outcomes. Review the 6-hour post-PCI monitoring trend and answer the two evaluation questions.

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> language: en  
> subject: System-Specific Assessments  
> category: ROR

## Question

Stage 6 — Evaluate outcomes. Review the 6-hour post-PCI monitoring trend and answer the two evaluation questions.

| Time | Data |
| --- | --- |
| Hour 0 (post-PCI) | HR 82, BP 128/80, SpO2 98%, ST elevation resolving to 0.5 mm, troponin I 1.2 ng/mL, urine output 52 mL/h. Client reports pain decreased to 2 out of 10. |
| Hour 2 | HR 72, BP 118/74, SpO2 98%, ST elevation 0.1 mm (near resolution), troponin I 15.4 ng/mL (expected washout rise), urine output 56 mL/h. |
| Hour 4 | HR 68, BP 112/70, SpO2 99%, ST resolved, troponin I 48.2 ng/mL (peak washout), urine output 60 mL/h. Pain 0 out of 10. |
| Hour 6 | HR 66, BP 110/68, SpO2 99%, ST resolved, troponin I 39.8 ng/mL (beginning to decline), urine output 58 mL/h. Oriented and resting comfortably. |

Q1. How is the client responding after primary PCI?

Clinically improving — expected post-reperfusion trends
Deteriorating — troponin rise indicates ongoing re-infarction
Stable but not improving

Q2. The nurse notes troponin I has risen from 1.2 to 48.2 ng/mL. What is the most appropriate response?

Notify the provider immediately — this indicates reinfarction or failed PCI
Continue routine post-PCI monitoring — troponin washout after successful reperfusion is expected and troponin is beginning to decline at hour 6
Prepare for emergency re-catheterization given the marked troponin elevation
Withhold antiplatelet medications due to perceived bleeding risk from troponin elevation

## Explanation

Normal Post-PCI Course
ST elevation resolution + HR·BP stabilization = successful reperfusion. Troponin surge (peak at Hour 2-4) = post-reperfusion washout — not reinfarction. Troponin decline starting at Hour 6 = further confirmation of reperfusion success. Urine output maintained = signal of maintained cardiac output.

## In-depth explanation

NCJMM Stage 6 — Evaluate Outcomes
Troponin elevation post-PCI is normal due to washout after reperfusion. Suspect re-infarction: ST re-elevation + recurrent chest pain + new hemodynamic deterioration. Dual antiplatelet therapy (DAPT): Maintain for at least 12 months post-PCI — continuous monitoring essential.

## Clinical scenario

Scenario (Stage 6 — Evaluate outcomes)
Review the 6-hour monitoring trends after successful primary PCI.

## Key concepts

- **재관류 후 트로포닌 상승** — PCI 성공 후 트로포닌은 세포 내 트로포닌 혈류로 방출되어 일시적 급상승(washout). 재경색의 트로포닌 상승: 하강 후 재상승 패턴 + 증상 재발.
- **PCI 성공 지표** — ST 해소(≥ 50% 감소), 흉통 소실, 혈역학 안정, 트로포닌 피크 후 하강, 소변량 유지.
- **DAPT 유지 기간** — PCI(DES) 후 DAPT 최소 12개월. 출혈 고위험 시 6개월 고려. DAPT 중단 or 중단 필요 시 심장전문의와 상의 필수.

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