Increased Risk of Non-Q Wave Myocardial Infarction After Directional Atherectomy Is Platelet Dependent: Evidence From the EPIC Trial

Lefkovits, Jeffrey; Blankenship, James C.; Anderson, K. M.; Stoner, G L; Talley, J. David; Worley, Seth J.; Weisman, H F; Califf, Robert M.; Topol, Eric J.

doi:10.1016/s0735-1097(96)00239-2

Cited by 55 publications

(20 citation statements)

References 27 publications

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“…These observations confirm the results of two previous studies, and show that the use of directed coronary atherectomy bears an increased risk of postprocedural non-Q-wave myocardial infarction after coronary interventions [36] and that rotablation in comparison to PTCA is a risk predictor of post-procedural Q wave as well as non-Q wave myocardial infarction [37] . For plain PTCA without adjunctive/alternative interventional techniques, in patients with heart failure NYHA class c3, the high risk groups are defined as follows: (1) male patients with heart failure class 3 and concomitant subacute myocardial infarction, (2) male patients with acute myocardial infarction and no pretreatment with aspirin or ACE inhibitors, but a high load of contrast medium within the procedure or, (3) female patients with an aPTT >35 s and complex stenosis morphology and/or high age >75 years.…”

Section: Discussionsupporting

confidence: 90%

A prognostic computer model to individually predict post-procedural complications in interventional cardiology; the INTERVENT Project

Budde

Haude²,

Höpp³

et al. 1999

European Heart Journal

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AimsThe purpose of this part of the INTERVENT project was (1) to redefine and individually predict post-procedural complications associated with coronary interventions, including alternative/adjunctive techniques to PTCA and (2) to employ the prognostic INTERVENT computer model to clarify the structural relationship between (pre)-procedural risk factors and post-procedural outcome. Methods and ResultsIn a multicentre study, 2500 data items of 455 consecutive patients (mean age: 61·1 8·3 years; 33-84 years) undergoing coronary interventions at three university centres were analysed. 80·4% of the patients were male, 16·7% had unstable angina, and 5·1%/10·1% acute/subacute myocardial infarction. There were multiple or multivessel stenoses in 16·0%, vessel bending >90 in 14·5%, irregular vessel contours in 65·0%, moderate calcifications in 20·9%, moderate/severe vessel tortuosity in 53·2% and a diameter stenosis of 90%-99% in 44·4% of cases. The in-lab (out-of-lab) complications were: 0·4% (0·9%) death, 1·8% (0·2%) abrupt vessel closure with myocardial infarction and 5·5% (4·0) haemodynamic disorders. ConclusionComputer algorithms derived from artificial intelligence were able to predict the individual risk of these post-procedural complications with an accuracy of >95% and to explain the structural relationship between risk factors and post-procedural complications. The most important prognostic factors were: heart failure (NYHA class), use of adjunctive/alternative techniques (rotablation, atherectomy, laser), acute coronary ischaemia, pre-existent cardiac medication, stenosis length, stenosis morphology (calcification), gender, age, amount of contrast agent and smoker status. Pre-medication with aspirin or other cardiac medication had a beneficial effect. Techniques, such as laser angioplasty or atherectomy were predictors for postprocedural complications. Single predictors alone were not able to describe the individual outcome completely. (Eur Heart J 1999; 20: 354-363)

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Section: Discussionsupporting

confidence: 90%

A prognostic computer model to individually predict post-procedural complications in interventional cardiology; the INTERVENT Project

Budde

Haude²,

Höpp³

et al. 1999

European Heart Journal

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“…2,7,8,21,22 The dominant role of platelets in this phenomenon is supported by evidence that a marked decrease in CK-MB elevation can be achieved with administration of potent antiplatelet agents such as glycoprotein IIb/IIIa inhibitors. 15,17,21,23 The present study suggests that lesion-specific factors may also be important for determination of CK-MB elevation. We found a strong relationship between baseline lesion characteristics (as assessed by preintervention IVUS) and subsequent CK-MB elevation.…”

Section: Discussionmentioning

confidence: 95%

“…7,8,21 Although the first 3 causes may be clinically apparent, the latter may be entirely asymptomatic and occur even during or after angiographically uneventful procedures. 2,7,8,21,22 The dominant role of platelets in this phenomenon is supported by evidence that a marked decrease in CK-MB elevation can be achieved with administration of potent antiplatelet agents such as glycoprotein IIb/IIIa inhibitors. 15,17,21,23 The present study suggests that lesion-specific factors may also be important for determination of CK-MB elevation.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][21][22][23] Compelling evidence suggests that the correlation of CK-MB elevation with poor clinical outcome is independent of the specific interventional device used. 21-23,26 -28 Known relationships exist between long-term patient outcome, atherosclerotic plaque burden, coronary calcification, and (even potentially) lesion remodeling characteristics.…”

Section: Lesion Characteristics and Ck-mb Elevationmentioning

confidence: 99%

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

et al. 2000

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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.)

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“…Percutaneous intervention for inoperable patients with LMT stenoses may be reasonable for those individuals with intractable symptoms. All groups of patients might be expected to have improved outcomes with adjunctive use of abciximab or related drugs, which have been demonstrated to decrease the risk of infarction with directional atherectomy 17 and emergency stenting 18 and are under study in the setting of elective stenting.…”

Section: Discussionmentioning

confidence: 99%

Contemporary Percutaneous Treatment of Unprotected Left Main Coronary Stenoses

et al. 1997

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This Article Abstract Google ScholarArticles by Ellis, S. G. Articles by Erbel, R. Search for Related Content PubMed PubMed CitationArticles by Ellis, S. G. Articles by Erbel, R. Pubmed/NCBI databases Medline Plus Health Information AngioplastyBackground Coronary artery bypass surgery (CABG) has been considered the therapy of choice for patients with unprotected left main (ULMT) coronary stenoses. Selected single-center reports suggest that the results of percutaneous intervention may now approach those of CABG.

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Increased Risk of Non-Q Wave Myocardial Infarction After Directional Atherectomy Is Platelet Dependent: Evidence From the EPIC Trial

Cited by 55 publications

References 27 publications

A prognostic computer model to individually predict post-procedural complications in interventional cardiology; the INTERVENT Project

A prognostic computer model to individually predict post-procedural complications in interventional cardiology; the INTERVENT Project

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

Contemporary Percutaneous Treatment of Unprotected Left Main Coronary Stenoses

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