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Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation.

Publication ,  Journal Article
Ricciardi, MJ; Wu, E; Davidson, CJ; Choi, KM; Klocke, FJ; Bonow, RO; Judd, RM; Kim, RJ
Published in: Circulation
June 12, 2001

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.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 12, 2001

Volume

103

Issue

23

Start / End Page

2780 / 2783

Location

United States

Related Subject Headings

  • Troponin I
  • Stents
  • Predictive Value of Tests
  • Necrosis
  • Myocardial Infarction
  • Middle Aged
  • Magnetic Resonance Imaging
  • Isoenzymes
  • Image Enhancement
  • Humans
 

Citation

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Ricciardi, M. J., Wu, E., Davidson, C. J., Choi, K. M., Klocke, F. J., Bonow, R. O., … Kim, R. J. (2001). Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation, 103(23), 2780–2783. https://doi.org/10.1161/hc2301.092121
Ricciardi, M. J., E. Wu, C. J. Davidson, K. M. Choi, F. J. Klocke, R. O. Bonow, R. M. Judd, and R. J. Kim. “Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation.Circulation 103, no. 23 (June 12, 2001): 2780–83. https://doi.org/10.1161/hc2301.092121.
Ricciardi MJ, Wu E, Davidson CJ, Choi KM, Klocke FJ, Bonow RO, et al. Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation. 2001 Jun 12;103(23):2780–3.
Ricciardi, M. J., et al. “Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation.Circulation, vol. 103, no. 23, June 2001, pp. 2780–83. Pubmed, doi:10.1161/hc2301.092121.
Ricciardi MJ, Wu E, Davidson CJ, Choi KM, Klocke FJ, Bonow RO, Judd RM, Kim RJ. Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation. 2001 Jun 12;103(23):2780–2783.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

June 12, 2001

Volume

103

Issue

23

Start / End Page

2780 / 2783

Location

United States

Related Subject Headings

  • Troponin I
  • Stents
  • Predictive Value of Tests
  • Necrosis
  • Myocardial Infarction
  • Middle Aged
  • Magnetic Resonance Imaging
  • Isoenzymes
  • Image Enhancement
  • Humans