Atherosclerotic Plaque Burden and CK-MB Enzyme Elevation After Coronary Interventions

Abstract

Background-Elevation of serum creatine kinase MB fraction (CK-MB) after percutaneous coronary interventions has been associated with early and late mortality; however, the pathogenesis of CK-MB elevation is still unknown. We hypothesized that CK-MB elevation was related to atherosclerotic plaque burden as assessed by preintervention intravascular ultrasound (IVUS). Methods and Results-We studied 2256 consecutive patients who underwent intervention of 2780 native coronary lesions and had complete high-quality preintervention IVUS imaging in the era before routine use of platelet glycoprotein IIb/IIIa inhibitors. Patients were divided into 3 groups: CK-MB within normal range (1675 patients; 2061 lesions); CK-MB elevation 1 to 5 times upper limit of normal (292 patients; 355 lesions); and CK-MB elevation Ն5 times upper limit of normal (289 patients; 364 lesions). Qualitative angiographic lesion morphology and quantitative analysis were similar among the 3 groups. On preintervention IVUS, progressively more reference segment and lesion site plaque burden and lesion site calcium occurred in the groups with CK-MB elevation. Positive remodeling was more common in lesions with CK-MB elevation. As levels of CK-MB increased, cross-sectional narrowing (percentage plaque burden) increased, both at the reference site (mean cross-sectional narrowing values were 45.1%, Ͻ49.3%, and Ͻ52.2% for normal CK-MB, 1 to 5 times upper limit of normal, and Ն5 times upper limit of normal groups, respectively; Pϭ0.03) and at the lesion site (81.9%, Ͻ85.4%, and Ͻ87.1%, respectively; Pϭ0.04). Multivariate analysis indicated that de novo lesions, atheroablative technique, plaque burden at the lesion and reference segments, and final minimal lumen diameter were independent predictors of CK-MB elevation. Conclusions-CK-MB elevation correlates with a greater atherosclerotic plaque burden. CK-MB elevation after intervention may be a marker of diffuse atherosclerotic disease or a consequence of catheter-based intervention in more diseased arteries or both. (Circulation. 2000;101:604-610.)

Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation

“…Moreover, atherosclerotic plaque burden and number of stents were higher in patients with a postprocedural rCVR Ͻ0.78, resembling the findings by Mehran et al 16 on the complex interplay between extent of atherosclerotic disease, extent of coronary intervention, and myocardial injury.…”

“…Cross-sectional narrowing (CSN), also called plaque burden, was calculated as (EEM CSAϪlumen CSA)/EEM CSA, where EEM is external elastic membrane and CSA is cross-sectional area. 15,16 …”

“…2,4 Among these, aggressiveness of the coronary procedure and atherosclerotic burden are considered most important. 16 However, catheter-based interventions other than coronary stenting and procedural complications such as side-branch occlusion were excluded from the present study to limit the extent of interfering variables. As far as coronary dissection is concerned, this complication was equally distributed among the study groups and was not associated with cardiac marker elevation in the present study.…”

Risk Factors of Cardiac Troponin T Elevation in Patients with Stable Coronary Artery Disease After Elective Coronary Drug‐Eluting Stent Implantation

“…One possible explanation was that regional myocardial damages occurred or local scar formed in patients with elevated troponin T. 21 Myocardial injury could impair left ventricular function and predispose to arrhythmic events, which influenced the survival and clinical outcomes. Alternatively, postprocedural troponin T elevation per se could be a biomarker of severe coronary artery disease, vulnerable coronary plaques, 22 or complicated coronary procedure. Our study supported the latter opinion.…”

Frequency, Risk Factors, and Effect on Long‐Term Survival of Increased Troponin I Following Uncomplicated Elective Percutaneous Coronary Intervention

“…These include multivessel or multilesion PCI, lesion length and complexity, presence of thrombus, rest angina, PCI of SVGs, use of multiple stents, older age, increased fluoroscopy time, and increased use of contrast media. 3,8,9,11 In a study of 2,256 patients undergoing PCI with intravascular ultrasound imaging, Mehran et al 12 found plaque burden to be a significant independent predictor of post-PCI CK-MB elevation.…”