Related Experiment Videos
[Predictive elements and prevention of myocardial damage during angioplasty/stenting]
Irene Bossi1, Stefano Savonitto, Claudio Cavallini
1I Divisione di Cardiologia, Dipartimento Cardiologico A. De Gasperis, Ospedale Niguarda Ca' Granda, Milano.
Insights
Cardiac enzyme elevation after percutaneous intervention is common and linked to worse outcomes. Strategies like glycoprotein IIb/IIIa inhibitors and protection devices may reduce these risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Context:
- Cardiac enzyme elevation (e.g., CK-MB) occurs in 5-30% of patients post-percutaneous intervention.
- This elevation is linked to increased risks of cardiac events and mortality.
- Causes are often unclear, but risk factors include unstable angina, diffuse atherosclerosis, and aggressive procedures.
Purpose:
- To review the causes, risk factors, and management strategies for cardiac enzyme elevation following percutaneous coronary intervention.
- To highlight the role of microembolization as a key pathogenetic mechanism.
- To discuss preventative measures and emerging technologies.
Summary:
- Microembolization of atherothrombotic plaque is a frequent cause of myocardial enzyme release post-intervention.
- Clinical, angiographic, and procedural factors contribute to CK-MB elevation.
- Platelet glycoprotein IIb/IIIa inhibitors and beta-blockers show potential benefits.
- Distal protection devices are under investigation for reducing periprocedural myocardial damage.
Impact:
- Understanding these factors aids in risk stratification and patient selection for interventions.
- Prophylactic use of glycoprotein IIb/IIIa inhibitors and protection devices can mitigate risks in high-risk patients.
- This knowledge can improve patient outcomes and reduce long-term mortality after coronary interventions.
Abstract:
Cardiac enzyme elevation is observed in 5-30% of patients after percutaneous intervention and appears associated with higher subsequent cardiac events and mortality. The cause of myocardial enzyme release could be an obvious angiographic complication of the procedure but, most frequently, is neither clinically nor angiographically clear. Different clinical series have identified clinical, angiographic and procedural risk factors for CK-MB elevation after otherwise successful coronary intervention, including unstable angina, diffuse atherosclerosis and aggressive procedures such as atheroablation. Microembolization of atherothrombotic plaque material appears to be the pathogenetic mechanism. Periprocedural administration of platelet glycoprotein IIb/IIIa inhibitors has been shown to reduce subsequent myocardial infarction and long-term mortality. Beta-blockers may also have a protective effect against post-procedural CK-MB elevations and follow-up cardiac events. New distal protection devices are under investigation and appear promising. The risk of inducing myocardial damage during percutaneous intervention should be considered before attempting the procedure. The use of platelet IIb/IIIa inhibitors and protection devices should be considered in high-risk patients.