Myonecrosis following stent placement: Association between impaired TIMI myocardial perfusion grade and MRI visualization of microinfarction

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 pos...

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Published in:Catheterization and cardiovascular interventions 2004-04, Vol.61 (4), p.472-476
Main Authors: Choi, James W., Gibson, C. Michael, Murphy, Sabina A., Davidson, Charles J., Kim, Raymond J., Ricciardi, Mark J.
Format: Article
Language:English
Subjects:
Adult
Aged
Biomarkers - blood
Blood Vessel Prosthesis Implantation
Coronary Angiography
coronary angioplasty
Creatine Kinase - blood
Creatine Kinase, MB Form
Female
Humans
Image Enhancement
Isoenzymes - blood
Magnetic Resonance Imaging
Male
microcirculation
Middle Aged
myocardial infarction
Myocardial Infarction - blood
Myocardial Infarction - diagnosis
Myocardial Infarction - etiology
Myocardial Reperfusion
Myocardium - metabolism
Myocardium - pathology
Necrosis
Postoperative Complications - blood
Postoperative Complications - diagnosis
Postoperative Complications - etiology
Severity of Illness Index
Statistics as Topic
Stents
Treatment Outcome
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Summary: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 × 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. Catheter Cardiovasc Interv 2004;61:472–476. © 2004 Wiley‐Liss, Inc.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.20024