Periprocedural myocardial injury during elective percutaneous coronary intervention: is it important and how can it be prevented?

Abstract

Periprocedural myocardial injury (PMI) is common after percutaneous coronary intervention (PCI). Periprocedural infarction (myocardial infarction type 4a) occurs after at least 10% of PCI procedures and has an impact on long-term prognosis. Measurement of biomarkers to allow assessment of PMI is an important tool for clinical and research purposes and should be routine after every PCI (troponin I or T and CK-MB). The importance of oral and intravenous antiplatelet agents and other drugs which have been proven to reduce PMI is discussed.

With the “Universal Definition,” Measurement of Creatine Kinase-Myocardial Band Rather Than Troponin Allows More Accurate Diagnosis of Periprocedural Necrosis and Infarction After Coronary Intervention

“…Current troponin thresholds are oversensitive with the arbitrary limit of 3 ϫ 99th percentile failing to discriminate between periprocedural necrosis and MI type 4a. (Myocardial Injury following Coronary Artery bypass Surgery versus Angioplasty: a randomised controlled trial using biochemical markers and cardiovascular magnetic resonance imaging; ISRCTN25699844) (J Am Coll Cardiol 2011;57:653-61) © 2011 by the American College of Cardiology Foundation Periprocedural myocardial injury (PMI) can result from procedural complications of percutaneous coronary intervention (PCI), such as distal embolization, sidebranch occlusion, coronary dissection, and disruption of collateral flow (1). In some of these cases a complication is clinically evident, but evidence of myocardial injury can also be detected after routine uneventful PCI procedures.…”

Platelet HPA-1 a/HPA-1 b polymorphism and the risk of periprocedural myocardial infarction in patients undergoing elective PCI

“…PMI has been shown in over 10% of patients undergoing PCI, mainly related to angiographically documented complications such as distal macroembolization, flow-limiting dissections or branch occlusions, however myonecrosis has been identified also in apparently uncomplicated PCI, therefore influencing prognosis [19,20]. Although the definition of periprocedural myocardial infarction is still debated, an increase of cardiac biomarkers over 3Â ULN has been related to a doubling of risk of major cardiac adverse events, both for troponin (OR 2.25, 95% CI 1.26 to 4.00, p ¼ 0.006) [21] or CK-MB (RR 2.82, p ¼ 0.03) [22].…”

Platelet PIA1/PIA2 polymorphism and the risk of periprocedural myocardial infarction in patients with acute coronary syndromes undergoing coronary angioplasty

“…It is mainly related to angiographically documented complications such as distal macroembolization, flow-limiting dissections or branch occlusions [21]. However, myocardial damage has been identified also in apparently uncomplicated PCI, therefore, influencing long-term outcome [7][8][22][23][24][25], especially in acute settings, mainly because the release of prothrombotic factors can cause platelet hyper-activation, leading to microvascular thrombosis, platelet plugging and, vasoconstriction [24][25][26][27], further compromising myocardial perfusion.…”