Abstract 15059: Elevation of Myocardial Necrosis Biomarkers After Surgical or Percutaneous Intervention Assessed by Cardiac Magnetic Resonance With Late Gadolinium Enhancement for Diagnostic of Procedure-Related Myocardial Injury. A Prospective Study Using the Third Definition of Myocardium Infarction
Background: We aimed to compare the release of cardiac biomarkers with the emergence of the new late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and to relate these results based on the settings of the third Task Force MI.
Methods: We prospectively studied 114 patients with stable multivessel coronary disease with formal indication for mechanical revascularization. Measurements of high-sensitive troponin I (cTnI) and creatine kinase (CKMB) were obtained before all the procedures, six, twelve, 24, and 36 hours after to PCI and, until 72 hours to CABG. CMR and LGE were performed in all patients before and after procedures. The diagnosis of MI was defined as up to 5 times and 10 times the 99th percentile, for PCI and CABG, respectively.
Results: Of 114 patients studied, 80 (70.2%) underwent CABG and 34 (29.8%) underwent PCI. For CABG patients, myocardial injury occurred in 75 (93.8%) with TnI and 18 (22.5%) with CKMB. For PCI patients, myocardial injury occurred in 23 (67.6%) with troponin and 4 (11.8%) with CKMB. 19 (17%) patients had new LGE on post procedure CMR. 17 (21%) after CABG and 2 (5.8%) after PCI. With the currents cutoffs, TnI has a sensitivity of 100% and specificity of 8.6% for CABG and a sensitivity of 100% and specificity of 36.7% for PCI. CKMB has a sensitivity of 52% and specificity of 84.5% for CABG and a sensitivity of 100% and specificity of 93% for PCI. Based on ROC curve, for CABG patients, the best cutoff of TnI was 3.14 ng/mL (78 times the 99th percentile) with a sensitivity of 76% and specificity of 62%, and of CKMB was 20.2 ng/mL (5 times the 99th percentile) with sensitivity of 70% and specificity of 59%.
Conclusion: Compared with LGE, CKMB reached better accuracy than cTnl for the diagnosis of myocardial injury. These data suggest a higher troponin cutoff for the diagnosis of procedure-related myocardial injury.
- © 2013 by American Heart Association, Inc.