Abstract 13339: Biomarkers Release After Percutaneous Coronary Intervention in Patients Without Definitive Miocardial Infarction Assessed by Cardiac Magnetic Ressonance With Late Gadolinium Enhancement. a Prospective Trial Using the Third Universal Definition of Myocardial Infarction
Introduction: Biomarker release after percutaneous coronary intervention (PCI) is a common phenomenon. However, the correlation between the release and the diagnosis of type 4a myocardial infarction (MI) has generated considerable controversy, especially after the emergence of high-sensitive cardiac troponin (cTn) assays. We aim to evaluate the amount and pattern of cardiac biomarkers release after elective PCI in patients without the presence of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) after the procedure, and interpret these findings based on the third Task Force definitions for MI.
Methods: In this prospective study, we evaluated stable multivessel coronary artery disease patients with preserved ventricular function and formal indication to PCI. CMR with LGE was performed in all patients before and after interventions. Measurements of cTn and creatine kinase (CK)-MB were performed systematically before and after the procedure, every 6 hours until 48h. Patients with a new LGE on the post procedure CMR were excluded. The release of troponin and CK-MB for diagnosis of procedure-related MI was defined as up to 5 times the 99th percentile.
Results: 62 patients completed this study. Of this, 07 (11.3%) were excluded because of the presence of a new LGE on the post procedure CMR. The 55 patients without a CMR-defined infarction were predominantly male 44 (65.7%), with a mean age of 61.2 (±12.6) years and Syntax score of 19.1 (±7.0). Despite the absence of a new LGE on post procedure CMR, 31 (56.4%) patients had a cTn peak higher than 5 times the 99th percentile, while only 1 (1.8%) patient had a CK-MB peak higher than 5 times the 99th percentile. The mean of cTn peak release was 1.06ng/dL (±1.67) that is 26.5 times higher the 99th percentile, with a maximum of 6.02ng/mL. The mean of CK-MB peak release was 4.78ng/dL (±5.5) that is 1.08 times higher the 99th percentile, with a maximum of 30.3ng/mL.
Conclusion: Post-PCI elevation of high-sensitive cTn higher than currently cut-off recommendations occurred frequently, without evidence of CMR-defined infarction. We suggest that the cTn threshold to define type 4a MI should be much higher than the CK-MB. Until than, CK-MB should represent the marker of choice to detect post-PCI myocardial necrosis.
Author Disclosures: R.M. Vieira de Melo: None. F.T. Oikawa: None. L.M. Costa: None. P.C. Rezende: None. T.L. Scudeler: None. C.H. Nomura: None. A.V. Villa: None. A.C. Hueb: None. W. Hueb: None. R. Kalil Filho: None.
- © 2014 by American Heart Association, Inc.