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Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Increased CK-MB release is a "trade-off" for optimal stent implantation: an intravascular ultrasound study
Ioannis Iakovou1, Gary S Mintz, George Dangas
1Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York 10022, USA.
Insights
Aggressive stent expansion in percutaneous coronary interventions increases creatine kinase-MB (CK-MB) release but reduces restenosis and adverse cardiac events. This suggests higher CK-MB release is a trade-off for optimal stent implantation and improved patient outcomes.
Area of Science:
- Cardiovascular Interventions
- Biomarker Release
- Clinical Outcomes
Background:
- Elevated creatine kinase-MB (CK-MB) post-percutaneous coronary intervention is linked to increased late mortality.
- Understanding factors influencing CK-MB release is crucial for improving patient prognosis after stenting.
Purpose of the Study:
- To evaluate the effect of aggressive stent expansion on creatine kinase-MB (CK-MB) release.
- To assess the impact of stent expansion on clinical restenosis rates.
Main Methods:
- Intravascular ultrasound-guided stenting was performed in 989 patients (1,015 lesions).
- Patients were stratified into three groups based on stent expansion ratio: <70%, 70-100%, and >100% (overexpansion).
Main Results:
- Peak CK-MB levels significantly increased with greater stent expansion (p=0.02).
- Target lesion revascularization and major adverse cardiac events decreased stepwise with increased stent expansion (p=0.04).
- A trend towards lower mortality was observed in the overexpansion group (p=0.07).
Conclusions:
- Intravascular ultrasound-guided stent overexpansion leads to higher periprocedural CK-MB release.
- Overexpansion is associated with reduced target lesion revascularization and a trend toward lower mortality at one year.
- Increased CK-MB release may be an acceptable trade-off for optimal stent implantation and reduced clinical restenosis.
Objectives:
We sought to determine the impact of aggressive stent expansion on creatine kinase-MB isoenzyme (CK-MB) release and clinical restenosis.
Background:
Elevation of CK-MB after percutaneous coronary interventions has been associated with late mortality.
Methods:
We identified 989 consecutive patients who underwent intravascular ultrasound-guided stenting of 1,015 coronary lesions. Patients were divided into three groups according to stent expansion, defined as the ratio of final lumen over the reference lumen cross-sectional areas: Group 1 (ratio <70%, n = 117 patients with 126 lesions); Group 2 (ratio 70% to 100%, n = 551 patients with 562 lesions); Group 3 (ratio >100%, n = 321 patients with 327 lesions).
Results:
The peak CK-MB values increased significantly with increasing stent expansion: CK-MB = 3 to 5x normal occurred 16%, 18%, and 25% in Groups 1, 2, and 3, respectively, p = 0.02; CK-MB >5 times normal occurred 9%, 13%, and 16% respectively, p = 0.02. Conversely, at one year follow-up there was a stepwise decrease in target lesion revascularization (11% vs. 19% and 17%, respectively, p = 0.04) and major adverse cardiac events with increasing stent expansion. In addition, there was a trend toward lower mortality in Group 3 (9% vs. 4.4% vs. 4.0%, p = 0.07).
Conclusions:
Intravascular ultrasound-guided stent overexpansion (final lumen greater than reference lumen cross-sectional area) is accompanied by a higher periprocedural CK-MB release but a lower target lesion revascularization and a trend toward lower mortality at one year. Increased periprocedural CK-MB release appears as a trade-off for optimal stent implantation and lower clinical restenosis.
