Circulation. 2001;103:2780-2783
doi: 10.1161/hc2301.092121
doi: 10.1161/hc2301.092121
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(Circulation. 2001;103:2780.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Visualization of Discrete Microinfarction After Percutaneous Coronary Intervention Associated With Mild Creatine Kinase-MB Elevation
From Feinberg Cardiovascular Institute (M.J.R., C.J.D., K.M.C., F.J.K., R.O.B., R.M.J., R.J.K.) and the Departments of Medicine (M.J.R., E.W., C.J.D., K.M.C., F.J.K., R.O.B., R.M.J., R.J.K.) and Biomedical Engineering (R.M.J.), Northwestern University, Chicago, Ill.
Correspondence to Raymond J. Kim, 303 East Chicago Ave, Tarry 12-733, Chicago, IL 60611-3008. E-mail r-kim4{at}northwestern.edu
Background—Mild elevations in creatine kinase-MB (CK-MB) are common after successful percutaneous coronary interventions and are associated with future adverse cardiac events. The mechanism for CK-MB release remains unclear. A new contrast-enhanced MRI technique allows direct visualization of myonecrosis.
Methods and Results—Fourteen patients without prior infarction underwent cine and contrast-enhanced MRI after successful coronary stenting; 9 patients had procedure-related CK-MB elevation, and 5 did not (negative controls). The mean age of all patients was 61 years, 36% had diabetes, 43% had multivessel coronary artery disease, and all had a normal ejection fraction. Twelve patients (86%) received an intravenous glycoprotein IIb/IIIa inhibitor; none underwent atherectomy, and all had final TIMI 3 flow. Of the 9 patients with CK-MB elevation, 5 had a minor side branch occlusion during stenting, 2 had transient ECG changes, and none developed Q-waves. The median CK-MB was 21 ng/mL (range, 12 to 93 ng/mL), which is 2.3x the upper limit of normal. Contrast-enhanced MRI demonstrated discrete regions of hyperenhancement within the target vessel perfusion territory in all 9 patients. Only one developed a new wall motion abnormality. The median estimated mass of myonecrosis was 2.0 g (range, 0.7 to 12.2 g), or 1.5% of left ventricular mass (range, 0.4% to 6.0%). Hyperenhancement persisted in 5 of the 6 who underwent a repeat MRI at 3 to 12 months. No control patient had hyperenhancement.
Conclusions—Contrast-enhanced MRI provides an anatomical correlate to biochemical evidence of procedure-related myocardial injury, despite the lack of ECG changes or wall motion abnormalities. Mild elevation of CK-MB after percutaneous coronary intervention is the result of discrete microinfarction.
Key Words: creatine kinase • magnetic resonance imaging • angioplasty
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M.T. Roe, K.W. Mahaffey, R. Kilaru, J.H. Alexander, K.M. Akkerhuis, M.L. Simoons, R.A. Harrington, B.E. Tardiff, C.B. Granger, E.M. Ohman, et al. Creatine kinase-MB elevation after percutaneous coronary intervention predicts adverse outcomes in patients with acute coronary syndromes Eur. Heart J., February 2, 2004; 25(4): 313 - 321. [Abstract] [Full Text] [PDF]
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H. P. Kuhl, T. S. Papavasiliu, A. M. Beek, M. B. M. Hofman, N. S. Heusen, and A. C. van Rossum Myocardial Viability: Rapid Assessment with Delayed Contrast-enhanced MR Imaging with Three-dimensional Inversion-Recovery Prepared Pulse Sequence Radiology, February 1, 2004; 230(2): 576 - 582. [Abstract] [Full Text] [PDF]
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J. B. Selvanayagam, S. E. Petersen, J. M. Francis, M. D. Robson, A. Kardos, S. Neubauer, and D. P. Taggart Effects of Off-Pump Versus On-Pump Coronary Surgery on Reversible and Irreversible Myocardial Injury: A Randomized Trial Using Cardiovascular Magnetic Resonance Imaging and Biochemical Markers Circulation, January 27, 2004; 109(3): 345 - 350. [Abstract] [Full Text] [PDF]
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W. G. van Dockum, F. J. ten Cate, J. M. ten Berg, A. M. Beek, J. W. R. Twisk, J. Vos, M. B. M. Hofman, C. A. Visser, and A. C. van Rossum Myocardial infarction after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: evaluation by contrast-enhanced magnetic resonance imaging J. Am. Coll. Cardiol., January 7, 2004; 43(1): 27 - 34. [Abstract] [Full Text] [PDF]
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D. O. Williams A twist in our understanding of enzyme elevation after coronary intervention J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1906 - 1908. [Full Text] [PDF]
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B. K. Nallamothu and E. R. Bates Periprocedural myocardial infarction and mortality: Causality versus association J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1412 - 1414. [Full Text] [PDF]
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C. J. White Angiographic predictors of adverse outcomes in the modern interventional era J. Am. Coll. Cardiol., September 17, 2003; 42(6): 989 - 990. [Full Text] [PDF]
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R. Y. Kwong, A. E. Schussheim, S. Rekhraj, A. H. Aletras, N. Geller, J. Davis, T. F. Christian, R. S. Balaban, and A. E. Arai Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging Circulation, February 4, 2003; 107(4): 531 - 537. [Abstract] [Full Text] [PDF]
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A. S. Kini, P. Lee, C. A. Mitre, M. E. Duffy, and S. K. Sharma Postprocedure chest pain after coronary stenting: implications on clinical restenosis J. Am. Coll. Cardiol., January 1, 2003; 41(1): 33 - 38. [Abstract] [Full Text] [PDF]
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L. Choudhury, H. Mahrholdt, A. Wagner, K. M. Choi, M. D. Elliott, F. J. Klocke, R. O. Bonow, R. M. Judd, and R. J. Kim Myocardial scarring in asymptomatic or mildly symptomatic patients with hypertrophic cardiomyopathy J. Am. Coll. Cardiol., December 18, 2002; 40(12): 2156 - 2164. [Abstract] [Full Text] [PDF]
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S. J. Brener, B. W. Lytle, J. P. Schneider, S. G. Ellis, and E. J. Topol Association between CK-MB elevation after percutaneous or surgical revascularization and three-year mortality J. Am. Coll. Cardiol., December 4, 2002; 40(11): 1961 - 1967. [Abstract] [Full Text] [PDF]
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J. R. Guyton Clinical Assessment of Atherosclerotic Lesions: Emerging From Angiographic Shadows Circulation, September 10, 2002; 106(11): 1308 - 1309. [Full Text] [PDF]
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E. C. Perin, G. V. Silva, R. Sarmento-Leite, A. L.S. Sousa, M. Howell, R. Muthupillai, B. Lambert, W. K. Vaughn, and S. D. Flamm Assessing Myocardial Viability and Infarct Transmurality With Left Ventricular Electromechanical Mapping in Patients With Stable Coronary Artery Disease: Validation by Delayed-Enhancement Magnetic Resonance Imaging Circulation, August 20, 2002; 106(8): 957 - 961. [Abstract] [Full Text] [PDF]
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