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

Mark J. Ricciardi, Edwin Wu, Charles J. Davidson, Kelly M. Choi, Francis J. Klocke, Robert O. Bonow, Robert M. Judd, Raymond J. Kim

Research output: Contribution to journalArticle

Abstract

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 2.3 × 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.

Original languageEnglish (US)
Pages (from-to)2780-2783
Number of pages4
JournalCirculation
Volume103
Issue number23
DOIs
StatePublished - Jun 12 2001
Externally publishedYes

Fingerprint

MB Form Creatine Kinase
Percutaneous Coronary Intervention
Creatine Kinase
Electrocardiography
Atherectomy
Platelet Glycoprotein GPIIb-IIIa Complex
Infarction
Coronary Artery Disease
Perfusion
Wounds and Injuries

Keywords

  • Angioplasty
  • Creatine kinase
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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

Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. / Ricciardi, Mark J.; Wu, Edwin; Davidson, Charles J.; Choi, Kelly M.; Klocke, Francis J.; Bonow, Robert O.; Judd, Robert M.; Kim, Raymond J.

In: Circulation, Vol. 103, No. 23, 12.06.2001, p. 2780-2783.

Research output: Contribution to journalArticle

Ricciardi, MJ, Wu, E, Davidson, CJ, Choi, KM, Klocke, FJ, Bonow, RO, Judd, RM & Kim, RJ 2001, 'Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation', Circulation, vol. 103, no. 23, pp. 2780-2783. https://doi.org/10.1161/hc2301.092121
Ricciardi, Mark J. ; Wu, Edwin ; Davidson, Charles J. ; Choi, Kelly M. ; Klocke, Francis J. ; Bonow, Robert O. ; Judd, Robert M. ; Kim, Raymond J. / Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. In: Circulation. 2001 ; Vol. 103, No. 23. pp. 2780-2783.
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abstract = "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 2.3 × 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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AU - Ricciardi, Mark J.

AU - Wu, Edwin

AU - Davidson, Charles J.

AU - Choi, Kelly M.

AU - Klocke, Francis J.

AU - Bonow, Robert O.

AU - Judd, Robert M.

AU - Kim, Raymond J.

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N2 - 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 2.3 × 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.

AB - 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 2.3 × 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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