New universal definition of myocardial infarction applicable after complex percutaneous coronary interventions?

Details

Serval ID
serval:BIB_E2D8B6B4208F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
New universal definition of myocardial infarction applicable after complex percutaneous coronary interventions?
Journal
Jacc. Cardiovascular Interventions
Author(s)
Locca D., Bucciarelli-Ducci C., Ferrante G., La Manna A., Keenan N.G., Grasso A., Barlis P., Del Furia F., Prasad S.K., Kaski J.C., Pennell D.J., Di Mario C.
ISSN
1876-7605[electronic]
Publication state
Published
Issued date
2010
Volume
3
Number
9
Pages
950-958
Language
english
Abstract
OBJECTIVES: This study aimed to characterize myocardial infarction after percutaneous coronary intervention (PCI) based on cardiac marker elevation as recommended by the new universal definition and on the detection of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR). It is also assessed whether baseline inflammatory biomarkers are higher in patients developing myocardial injury. BACKGROUND: Cardiovascular magnetic resonance accurately assesses infarct size. Baseline C-reactive protein (CRP) and neopterin predict prognosis after stent implantation.
METHODS: Consecutive patients with baseline troponin (Tn) I within normal limits and no LGE in the target vessel underwent baseline and post-PCI CMR. The Tn-I was measured until 24 h after PCI. Serum high-sensitivity CRP and neopterin were assessed before coronary angiography.
RESULTS: Of 45 patients, 64 (53 to 72) years of age, 33% developed LGE with infarct size of 0.83 g (interquartile range: 0.32 to 1.30 g). A Tn-I elevation >99% upper reference limit (i.e., myocardial necrosis) (median Tn-I: 0.51 μg/l, interquartile range: 0.16 to 1.23) and Tn-I > 3× upper reference limit (i.e., type 4a myocardial infarction [MI]) occurred in 58% and 47% patients, respectively. LGE was undetectable in 42% and 43% of patients with periprocedural myocardial necrosis and type 4a MI, respectively. Agreement between LGE and type 4a MI was moderate (kappa = 0.45). The levels of CRP or neopterin did not significantly differ between patients with or without myocardial injury, detected by CMR or according to the new definition (p = NS).
CONCLUSIONS: This study reports the lack of substantial agreement between the new universal definition and CMR for the diagnosis of small-size periprocedural myocardial damage after complex PCI. Baseline levels of CRP or neopterin were not predictive for the development of periprocedural myocardial damage.
Keywords
C-reactive protein, cardiovascular magnetic resonance imaging, distal embolization, neopterin, percutaneous coronary interventions, intravascular ultrasound, troponin elevation, perfusion grade, artery-disease, embolization, metaanalysis, neopterin, insights, angina, trial
Pubmed
Web of science
Open Access
Yes
Create date
27/10/2010 14:29
Last modification date
20/08/2019 16:06
Usage data