Minor Myocardial Damage and Prognosis

Abstract

Background-The relevance of the adverse prognostic implications of CK-MB elevation after percutaneous coronary intervention (PCI) remains controversial. Therefore, we compared the relationship between the level of postprocedural CK-MB elevation and 6-month mortality in patients undergoing PCI with the relationship between the level of spontaneous, non-PCI-related CK-MB elevation and 6-month mortality in patients with acute coronary syndromes (ACS) treated medically. Methods and Results-In the PURSUIT trial, 5583 of 9461 patients who presented with a non-ST-elevation ACS did not undergo PCI or CABG and had at least 1 CK-MB sample collected during index-hospitalization. There was a gradual increase in 6-month mortality with higher CK-MB levels: 4.1%, 8.6%, 9.0%, 14.3%, 15.5% for CK-MB ratios 0 to 1, Ͼ1 to 3, Ͼ3 to 5, Ͼ5 to 10, and Ͼ10 times the upper limit of normal. A combined analysis in 8838 patients undergoing PCI in 5 large, clinical trials revealed a proportional relationship between postprocedural CK-MB levels (Յ48 hours after PCI) and 6-month mortality. In patients with CK-MB ratios 0 to 1, Ͼ1 to 3, Ͼ3 to 5, Ͼ5 to 10, and Ͼ10, the risk of death was 1.3%, 2.0%, 2.3%, 4.3%, and 7.4%, respectively. The absolute mortality rates were lower after procedure-related infarcts compared with spontaneous infarcts. Yet, the relative increase in 6-month mortality with each increase in peak CK-MB level was similar for PCI-related myocardial necrosis and spontaneous myocardial necrosis, as all tests for heterogeneity of the odds ratios were nonsignificant. Conclusions-The present analysis indicates that the adverse prognostic implications of periprocedural myocardial necrosis should be considered similar to the adverse consequences of spontaneous myocardial necrosis. (Circulation. 2002;105:554-556.)

Avaliação comparativa do valor prognóstico de quatro marcadores bioquímicos de lesão miocárdica pós intervenções percutâneas utilizando stents coronarianos

“…In only one patient, that value was exceeded, characterizing periprocedure infarction. The percentage of elevations in CK-MB activity in our study are lower than those reported in the literature, usually occurring in 15 to 25% of the patients 2,6,7 . This may be attributed to the exclusion of patients more prone to enzyme release (patients with lesions in the saphenous vein graft and those with recent acute coronary syndrome) 8,9 , and also to the influence of the technical characteristics and controlled invasiveness strategy that characterized our interventions (total time of balloon inflation < 120 seconds in 87% of the patients, maximum pressure of stent deployment ≤ 16 atmospheres in 70%, direct implantation of the prosthesis in 45% of the patients).…”

Relationship Between Duke Treadmill Score and Coronary Artery Lesion Complexity

“…Also, there was a signicantly increased SxScore in patients with higher risk groups, as (7,8) .Wykrzykowska et al demonstrated the independent predictive value of SxScore for MACEs and mortality, not only in selected patient groups but also in all CAD treated by percutaneous coronary intervention (9).…”

Effect of Intracoronary Nicardipine on Cardiac Enzymes After Elective Percutaneous Coronary Intervention

“…18 Finally, adverse prognostic implications of minor postprocedural myocardial damage may be similar to that of myocardial necrosis associated with an ACS. 19 Nevertheless, the results of the study were unchanged when a less strict definition of elevation in troponin I levels of ≥3× normal was used.…”