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Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine
M J Ricciardi1, E Wu, C J Davidson
1Feinberg Cardiovascular Institute and the Department of Medicine, Northwestern University, Chicago, IL, USA.
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 2.3x 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.
Insights
Mild elevations in creatine kinase-MB (CK-MB) after percutaneous coronary intervention indicate microinfarction. Contrast-enhanced MRI visualizes this myocardial injury, correlating with CK-MB levels.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Mild creatine kinase-MB (CK-MB) elevations are common after percutaneous coronary interventions (PCI).
- The mechanism behind CK-MB release post-PCI is not fully understood.
- Contrast-enhanced MRI offers direct visualization of myocardial necrosis.
Purpose of the Study:
- To investigate the mechanism of mild CK-MB elevation after PCI.
- To correlate biochemical markers of myocardial injury with anatomical findings using MRI.
- To assess the utility of contrast-enhanced MRI in detecting procedure-related myocardial damage.
Main Methods:
- 14 patients without prior infarction underwent cine and contrast-enhanced MRI post-PCI.
- Patients were categorized based on CK-MB elevation (9 with, 5 without).
- MRI assessed for hyperenhancement and wall motion abnormalities; CK-MB levels were measured.
Main Results:
- All 9 patients with CK-MB elevation showed discrete hyperenhancement on MRI, indicating myonecrosis.
- The median estimated mass of myonecrosis was 2.0 g (1.5% of LV mass).
- Only one patient developed a new wall motion abnormality; hyperenhancement persisted in most repeat scans.
Conclusions:
- Contrast-enhanced MRI confirms procedure-related myocardial injury despite normal ECG or wall motion.
- Mild CK-MB elevation post-PCI is a result of discrete microinfarction.
- MRI provides an anatomical basis for biochemical evidence of myocardial injury.
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