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Abnormal coronary flow velocity reserve after coronary intervention is associated with cardiac marker elevation
J Herrmann1, M Haude, A Lerman
1Department of Cardiology, University Clinic Essen, Essen, Germany.
Insights
Reduced coronary flow velocity reserve after stenting often indicates microvascular impairment. This study shows reduced rCVR is linked to cardiac enzyme elevation, suggesting microvascular injury from embolization during coronary procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Microvascular Physiology
Background:
- Reduced relative coronary flow velocity reserve (rCVR) post-coronary intervention is linked to microvascular impairment.
- The incidence of cardiac enzyme elevation as a marker of embolic myocardial injury in these cases remains understudied.
Purpose of the Study:
- To investigate the incidence of cardiac enzyme elevation (creatine kinase and troponin T) after successful coronary stenting.
- To determine the correlation between postprocedural rCVR and cardiac enzyme elevation.
- To identify a cutoff value for rCVR to predict myocardial injury.
Main Methods:
- 55 patients undergoing successful coronary stenting with periprocedural intracoronary Doppler analysis were studied.
- Creatine kinase (CK) and cardiac troponin T (cTnT) levels were measured before and up to 24 hours post-intervention.
- Correlation and receiver operating characteristic (ROC) analyses were performed to assess the relationship between rCVR and enzyme elevation.
Main Results:
- Postprocedural rCVR independently correlated with cTnT (r=-0.498, P<0.001) and CK elevation (r=-0.406, P=0.002).
- An rCVR cutoff of 0.78 best discriminated cTnT and CK elevation (sensitivity 83.3%/69.2%, specificity 79.1%/76.2%).
- Patients with rCVR <0.78 had significantly higher rates of cTnT (52.6%) and CK (36.8%) elevation compared to those with rCVR ≥0.78 (5.6% for both, P<0.001).
Conclusions:
- Cardiac marker elevation is frequent after coronary procedures associated with reduced rCVR.
- Persistent reduction in rCVR suggests procedural embolization of atherothrombotic debris.
- Microvascular impairment and myocardial injury are potential underlying mechanisms for enzyme elevation post-intervention.
Background:
Residual reduction of relative coronary flow velocity reserve (rCVR) after successful coronary intervention has been related to microvascular impairment. However, the incidence of cardiac enzyme elevation as a surrogate marker of an underlying embolic myocardial injury in these cases has not been studied.
Methods And Results:
A series of 55 consecutive patients with successful coronary stenting, periprocedural intracoronary Doppler analysis, and determination of creatine kinase (CK; upper limit of normal [ULN] for women 70 IU/L, for men 80 IU/L) and cardiac troponin T (cTnT; bedside test, threshold 0.1 ng/mL) before and 6, 12, and 24 hours after intervention were studied. Postprocedural rCVR was the only intracoronary Doppler parameter that independently correlated with cTnT (r=-0.498, P<0.001) and CK outcome (r=-0.406, P=0.002). Receiver operating characteristic analysis identified a postprocedural rCVR of 0.78 as the best discriminating value, with a sensitivity of 83.3% and 69.2% and a specificity of 79.1% and 76.2% for detection of cTnT and CK elevation, respectively. Stratified according to this cutoff value, the incidence of cTnT elevation was 52.6% in patients with (n=19) and 5.6% in patients without (n=36) a postprocedural rCVR <0.78 (P<0.001), associated with a CK elevation >1 times the ULN in 36.8% and 5.6% (P=0.005) of patients, respectively.
Conclusions:
Cardiac marker elevation can frequently be found after coronary procedures that are associated with a persistent reduction of rCVR, indicating procedural embolization of atherothrombotic debris with microvascular impairment and myocardial injury as a potential underlying mechanism.
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