Key result
A poststent decline in TIMI myocardial perfusion grade was associated with more frequent extensive myonecrosis compared to no decline (100% vs 18.2%; P=0.03).
Why the study?
Does a poststent decline in TIMI myocardial perfusion grade associate with higher CK-MB and larger infarct mass on MRI in poststent patients?
Case-Control (n=14)
Does a poststent decline in TIMI myocardial perfusion grade associate with higher CK-MB and larger infarct mass on MRI in poststent patients?
Absolute Event Rate: 100% vs 18.2%
p-value: p=0.03
A poststent decline in TIMI myocardial perfusion grade is associated with larger infarct mass and higher CK-MB, supporting microvascular obstruction as a cause of procedure-related myonecrosis.
May indicate microvascular obstruction in myonecrosis; hypothesis-generating and requires prospective validation before clinical use.
Contrast-enhanced cardiac MRI (ceMRI) and TIMI myocardial perfusion grade analysis (TMPG) are proven methods for visualization of microinfarction and assessment of microvascular perfusion, respectively. To determine whether microvascular obstruction accounts for procedure-related myonecrosis, 14 poststent patients, 9 with procedural CK-MB elevation and 5 controls, underwent ceMRI and TMPG. All had TIMI 3 flow pre- and poststent. TMPG was normal in 12/14 pre- and 7/14 poststent. Those with poststent decline in TMPG had higher CK-MB (median, 41.0 vs. 7.4 ng/mL; P = 0.01) and larger infarct mass (median, 3.1 vs. 0.89 g; P = 0.04). More extensive myonecrosis (CK-MB > 3 x normal; infarct mass > 3 g) was observed more frequently if there was a poststent decline in TMPG (3/3, 100%, vs. 2/11, 18.2%; P = 0.03). These data support the theory that distal embolization and microvascular obstruction are associated with myonecrosis following otherwise successful coronary stent placement and provide further insight into its pathophysiology.
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Choi et al. (2004) conducted a case-control in Myonecrosis following coronary stent placement (n=14). Poststent decline in TIMI myocardial perfusion grade (TMPG) vs. No poststent decline in TMPG was evaluated on Extensive myonecrosis (CK-MB > 3 x normal; infarct mass > 3 g) (p=0.03). A poststent decline in TIMI myocardial perfusion grade was associated with more frequent extensive myonecrosis compared to no decline (100% vs 18.2%; P=0.03).
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