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Phrommintikul A, Chanchai R, Wongcharoen W. Effects of Curcuminoids on Myocardial Injury After Percutaneous Coronary Intervention. J Med Food 2019; 22:680-684. [PMID: 31045465 DOI: 10.1089/jmf.2018.4321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The rise of cardiac troponin post-percutaneous coronary intervention (PCI) is associated with a high risk of long-term cardiovascular events. Previous studies have shown that curcuminoids decreased myocardial injury post-coronary bypass graft surgery through anti-oxidant and anti-inflammatory effects. We sought to examine whether curcuminoids could prevent PCI-related myocardial injury. One-hundred enrolled patients receiving elective PCI were randomized to obtain curcuminoids or placebo 4 g/day at least 1 day before and after the scheduled PCI. Cardiac troponin-T and 12-lead electrocardiogram were evaluated before PCI and at 24 and 48 h post-PCI. The definitions of PCI-related myocardial injury and myocardial infarction were in line with the third universal definition of myocardial infarction. Baseline characteristics of patients and procedures did not differ between the curcuminoids and placebo groups. The mean age was 63.9 ± 10.8 years. The incidence of PCI-related myocardial injury was not different between curcuminoids and placebo groups (32% vs. 38%, P = .675). The peak high-sensitive cardiac troponin T levels after PCI were not different between the curcuminoids and placebo groups (201.0 ± 547.0 ng/L vs. 187.0 ± 703.9 ng/L respectively, P = .912). Further, the high-sensitive C-reactive protein levels post-PCI were similar in patients receiving curcuminoids and placebo (7.2 ± 18.8 mg/dL vs. 6.6 ± 17.5 mg/dL, respectively, P = .873). We found that short-term treatment with curcuminoids did not reduce the occurrence of PCI-related myocardial injury. We did not observe the role of anti-oxidative and anti-inflammatory effects of curcuminoids in the PCI-related myocardial injury.
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Affiliation(s)
- Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Rattanachai Chanchai
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wanwarang Wongcharoen
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Huber K. Current Definitions of Non-ST-Segment Elevation Myocardial Infarction: Challenges for Further Improvement. JACC Cardiovasc Interv 2018; 11:865-867. [PMID: 29747916 DOI: 10.1016/j.jcin.2018.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Kurt Huber
- 3rd Medicine Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria; and Sigmund Freud University, Medical School, Vienna, Austria.
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Capodanno D, Caterina RD. Bivalirudin for acute coronary syndromes: premises, promises and doubts. Thromb Haemost 2017; 113:698-707. [DOI: 10.1160/th14-09-0765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 10/10/2014] [Indexed: 12/30/2022]
Abstract
SummaryBivalirudin is a valuable anticoagulant option in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention. Advantages over heparin as a parenteral anticoagulant include more predictable pharmacokinetics and pharmacodynamics, shorter half-life, no need for cofactors, some degree of antiplatelet effect, and the ability to inhibit clot-bound thrombin. Clinical evidence supporting the use of bivalirudin over heparin in current ACS guidelines, however, derives mostly from early randomised trials that may no longer reflect current management patterns, now including the use of oral antiplatelet agents more potent than clopidogrel (i.e. prasugrel or ticagrelor) and a broader implementation of strategies to reduce bleeding (i.e. radial access for percutaneous coronary intervention, and use of glycoprotein IIb/IIIa inhibitors only in bailout situations). Defining the fine balance between bivalirudin efficacy and safety over heparins in the context of other antithrombotic treatments remains a challenge in clinical practice, particularly in a fast-evolving scenario, such as ACS, where numerous new trials have been presented in very recent times. Here we provide an up-to-date overview of the evidence on the use of bivalirudin in ACS, with focus on new data, open issues, and future directions.
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Cortese B, Aranzulla TC, Godino C, Chizzola G, Zavalloni D, Tavasci E, De Benedictis M, Ettori F, Presbitero P, Colombo A. Drug-eluting stent use after coronary atherectomy: results from a multicentre experience - The ROTALINK I study. J Cardiovasc Med (Hagerstown) 2017; 17:665-72. [PMID: 25575276 DOI: 10.2459/jcm.0000000000000227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Until now, there is no medium- to long-term clinical evidence of the best treatment after rotational atherectomy. METHODS From the databases of seven high-volume centres, years 2005-2010, we retrospectively analysed the long-term outcome of patients who had undergone rotational atherectomy followed by plain-balloon angioplasty or implantation of drug-eluting stent (DES) or bare metal stent (BMS). Primary endpoint was the incidence of major adverse cardiovascular events (MACE: death, myocardial infarction, target-lesion-revascularization) at longest available follow-up. RESULTS In this registry, we enrolled 1397 patients with 1605 lesions, followed for 28.4 ± 21 months. DES-treated patients were more frequently diabetic, had more lesions treated and received a higher number of stents. In-hospital MACEs were significantly higher in DES patients (7.6 vs. 2.6 vs. 2.9%, respectively, P = 0.0001 for both), mainly due to a higher incidence of myocardial infarction (6.4 vs. 1.2 vs. 2.1%, P = 0.0001). The 2-year follow-up showed a significantly lower incidence of MACE in DES patients (15.1 vs. 24.2 vs. 20.8%, P = 0.001 for both), driven by a lower incidence of target-lesion revascularization (8 vs. 14.6 vs. 13.9%, P = 0.002). Myocardial infarction rate was lower in the DES group as well (0.4 vs. 3.1% in BMS, P = 0.001). At multivariate analysis, BMS implantation and balloon angioplasty were independent predictors of long-term MACE. DES implantation was associated with a lower risk of long-term myocardial infarction [hazard ratio 0.15, 95% confidence interval (95% CI) 0.04-0.67] and target-lesion revascularization (hazard ratio 0.42, 95% CI 0.21-0.82). Male sex and DES use were independent predictors of the absence of MACE. CONCLUSION After rotational atherectomy, DES implantation appears to be a preferable strategy, as it is associated with lower long-term MACE, despite an unexpected increase in periprocedural myocardial infarction.
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Affiliation(s)
- Bernardo Cortese
- aUnit of Interventional Cardiology, A.O. Fatebenefratelli, Milan bDepartment of Interventional Cardiology, Ospedale Mauriziano Umberto I, Torino cDepartment of Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan dDepartment of Interventional Cardiology, Spedali Civili, Brescia eDepartment of Interventional Cardiology, Cliniche Humanitas, Milan fDepartment of Interventional Cardiology, Ospedale Moriggia-Pelascini, Gravedona, Italy
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De Innocentiis C, Zimarino M, De Caterina R. Is Complete Revascularisation Mandated for all Patients with Multivessel Coronary Artery Disease? Interv Cardiol 2017; 13:45-50. [PMID: 29593837 DOI: 10.15420/icr.2017:23:1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In multivessel coronary artery disease (MVCAD), myocardial revascularisation can be achieved by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), with complete revascularisation on all diseased coronary segments or with incomplete revascularisation on selectively targeted lesions. Complete revascularisation confers a long-term prognostic benefit, but is associated with a higher rate of periprocedural events compared with incomplete revascularisation. In most patients with MVCAD, the main advantage of CABG over PCI is conferred by the achievement of more extensive revascularisation. According to current international guidelines, PCI is generally preferred in single-vessel disease, low-risk MVCAD or isolated left main disease; whereas CABG is usually recommended in patients with complex two-vessel disease, most patients with three-vessel disease and/or non-isolated left main disease. In patients with MVCAD, the choice on revascularisation modality should depend on a multifactorial evaluation, taking into account not only coronary anatomy, the ischaemic burden, myocardial function, age and the presence of comorbidities, but also the adequacy of myocardial revascularisation.
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Affiliation(s)
- Carlo De Innocentiis
- Institute of Cardiology and Centre of Excellence on Ageing, "G. d'Annunzio" University of Chieti-Pescara,Chieti, Italy
| | - Marco Zimarino
- Institute of Cardiology and Centre of Excellence on Ageing, "G. d'Annunzio" University of Chieti-Pescara,Chieti, Italy
| | - Raffaele De Caterina
- Institute of Cardiology and Centre of Excellence on Ageing, "G. d'Annunzio" University of Chieti-Pescara,Chieti, Italy
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Ndrepepa G, Braun S, Cassese S, Mayer K, Lohaus R, Lahmann AL, Fusaro M, Laugwitz KL, Schunkert H, Kastrati A. Valor pronóstico de la troponina T de alta sensibilidad tras intervención coronaria percutánea en pacientes con enfermedad coronaria estable. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Xu LX, Chen KY, Liu T, Zheng XT, Jiao ZQ, Xu Y, Li G. Adjunctive loading dose of cilostazol in preventing periprocedural myocardial infarction. Cardiovasc Ther 2016; 34:225-33. [PMID: 27133311 DOI: 10.1111/1755-5922.12192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Ling-Xia Xu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Kang-Yin Chen
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Tong Liu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Xin-Tian Zheng
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Zhan-Quan Jiao
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Yanmin Xu
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
| | - Guangping Li
- Department of Cardiology; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease; Tianjin Institute of Cardiology; Second Hospital of Tianjin Medical University; Tianjin China
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Ndrepepa G, Braun S, Cassese S, Mayer K, Lohaus R, Lahmann AL, Fusaro M, Laugwitz KL, Schunkert H, Kastrati A. Prognostic Value of High-sensitivity Troponin T After Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease. ACTA ACUST UNITED AC 2016; 69:746-53. [PMID: 27230475 DOI: 10.1016/j.rec.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/01/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The prognostic value of high-sensitivity troponin T after percutaneous coronary intervention in patients with stable coronary artery disease is unclear. We investigated this clinically relevant question in 3463 consecutive patients undergoing percutaneous coronary intervention. METHODS This study included patients with stable coronary artery disease and baseline high-sensitivity troponin T below the 99th percentile upper reference limit (0.014μg/L). High-sensitivity troponin T was measured before and at 6, 12 and 24hours after the procedure. The primary outcome was all-cause mortality. RESULTS Patients were divided into a group with peak postprocedural troponin T≤99th percentile (n=742), a group with peak postprocedural troponin T>99th to 5×99th percentile (n=1928), and a group with peak postprocedural troponin T>5×99th percentile upper reference limit (n=793). Advanced age, smaller body mass index, baseline troponin level, complex lesions, bifurcation lesions and stented length were independently associated with elevated troponin T levels after the procedure. The median follow-up was 15.5 months. There were 56 deaths: 5 deaths (1.7%) among patients with peak postprocedural troponin T≤99th percentile, 35 deaths (4.5%) among patients with peak postprocedural troponin T>99th to 5×99th percentile and 16 deaths (4.3%) among patients with peak postprocedural troponin T>5×99th percentile upper reference limit (hazard ratio=1.50; 95% confidence interval, 1.01-2.25; P=.047). After adjustment, peak postprocedural troponin T level was not independently associated with mortality after percutaneous coronary intervention (P=.094). CONCLUSIONS In patients with stable coronary artery disease and without elevated baseline high-sensitivity troponin T, elevated high-sensitivity troponin T level after percutaneous coronary intervention was not associated with postprocedural mortality.
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Affiliation(s)
- Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
| | - Siegmund Braun
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Salvatore Cassese
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Katharina Mayer
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Raphaela Lohaus
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Anna L Lahmann
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Massimiliano Fusaro
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Medizinische Klinik und Poliklinik I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Partner Site Munich Heart Alliance, Munich, Germany
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Zimarino M, Angeramo F, Prasad A, Ruggieri B, Malatesta S, Prati F, Buttitta F, De Caterina R. Reduction of atherothrombotic burden before stent deployment in non-ST elevation acute coronary syndromes: Reduction of myocardial necrosis achieved with nose-dive manual thrombus aspiration (REMNANT) trial. A volumetric intravascular ultrasound study. Catheter Cardiovasc Interv 2015; 88:716-725. [PMID: 26527239 DOI: 10.1002/ccd.26301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/01/2015] [Accepted: 10/02/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To test whether thrombus aspiration (TA) reduces the atherosclerotic burden in culprit lesions and "facilitate" percutaneous coronary intervention with stent (S-PCI) among patients with non-ST elevation acute coronary syndromes (NSTE-ACS). BACKGROUND Evidence on the effects of TA adjunctive to S-PCI in NSTE-ACS is limited and controversial. METHODS TA was defined "aggressive" when using 7F devices or a catheter/artery ratio >0.6, "conservative" with 6F, and a catheter/artery ratio ≤0.6. Angiography and intravascular ultrasound (IVUS) were performed at baseline, after TA and after stent deployment. RESULTS TA was accomplished in 61/76 patients (80%) with NSTE-ACS. The aspirated material was red thrombus in 23% and plaque fragments in 49% of cases. Compared with baseline, TA was associated with an 82% increase in minimal lumen diameter and a 15% reduction in diameter stenosis (P < 0.001 for both). After TA, IVUS documented a 24 and 16% increase in minimal lumen area and lumen volume, respectively (P < 0.001 for both), a 7% decrease in area stenosis through an 11% reduction of plaque + media volume (P < 0.001). When compared with "conservative", an "aggressive" TA was associated with a more pronounced reduction in percent area stenosis (P < 0.05) and an increase in percent stent expansion (P < 0.001). The plaque + media volume reduction after TA was correlated with stent expansion (r = 0.261, P = 0.046). CONCLUSIONS Manual TA reduces atherothrombotic burden in culprit lesions of NSTE-ACS patients before S-PCI and, when deep plaque removal is obtained, TA optimizes subsequent stent expansion. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Francesca Angeramo
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Abhiram Prasad
- Interventional Cardiology at St George's, University of London, London, United Kingdom
| | - Benedetta Ruggieri
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Sara Malatesta
- Institute of Pathology and Cardiovascular and Oncological Molecular Medicine, Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Francesco Prati
- Catheterization Laboratory, San Giovanni Hospital, Rome, Italy
| | - Fiamma Buttitta
- Institute of Pathology and Cardiovascular and Oncological Molecular Medicine, Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Raffaele De Caterina
- Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy
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Zimarino M, Ricci F, Romanello M, Di Nicola M, Corazzini A, De Caterina R. Complete myocardial revascularization confers a larger clinical benefit when performed with state-of-the-art techniques in high-risk patients with multivessel coronary artery disease: A meta-analysis of randomized and observational studies. Catheter Cardiovasc Interv 2015; 87:3-12. [DOI: 10.1002/ccd.25923] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/08/2015] [Indexed: 01/17/2023]
Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
| | - Fabrizio Ricci
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
| | - Mattia Romanello
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
| | - Marta Di Nicola
- Laboratory of Biostatistics; Department of Experimental and Clinical Science; “G, d'Annunzio” University; Chieti Italy
| | - Alessandro Corazzini
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
| | - Raffaele De Caterina
- Institute of Cardiology and Center of Excellence on Aging; “G, d'Annunzio” University; Chieti Italy
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11
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Sugiyama T, Kimura S, Akiyama D, Hishikari K, Kawaguchi N, Kamiishi T, Hikita H, Takahashi A, Isobe M. Quantitative assessment of tissue prolapse on optical coherence tomography and its relation to underlying plaque morphologies and clinical outcome in patients with elective stent implantation. Int J Cardiol 2014; 176:182-90. [DOI: 10.1016/j.ijcard.2014.07.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/28/2014] [Accepted: 07/05/2014] [Indexed: 11/28/2022]
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Abstract
OBJECTIVES To evaluate the clinical utility of and demand for the creatine kinase (CK)-MB assay. METHODS We examined the number of CK-MB tests from 2007 through 2013 while we progressively deemphasized their use. We first removed CK-MB from the acute coronary syndrome (ACS) panel and then from the main menu and observed the demand for the test. We also reviewed patient medical records to assess the appropriateness of its use. RESULTS After removing CK-MB from the ACS panel, the test volume dropped from around 12,000 per year to about 150 per year. In reviewing the records of 171 patients who had CK-MB determination done over a 28-month period, we discovered that CK-MB contributed to the diagnosis in only one patient, although it was not essential. Since removing CK-MB from the laboratory menu, two CK-MB tests were ordered in 4 months, and neither added value. CONCLUSIONS CK-MB determinations do not add value to information available from the troponin assay and can be safely removed from the laboratory menu.
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Affiliation(s)
- Gurmukh Singh
- School of Medicine, University of Missouri–Kansas City, Kansas City
- Truman Medical Center, Kansas City, MO
- Heritage Labs International, Olathe, KS
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Wang Z, Sato A, Akiyama D, Kimura T, Tajiri K, Hoshi T, Sakai S, Koike A, Miyauchi T, Aonuma K. Clinical value of plasma pentraxin 3 levels for predicting cardiac troponin elevation after percutaneous coronary intervention. Life Sci 2013; 95:40-4. [PMID: 24333560 DOI: 10.1016/j.lfs.2013.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/10/2013] [Accepted: 11/29/2013] [Indexed: 11/15/2022]
Abstract
AIMS Post-procedural myocardial necrosis manifested by elevated cardiac troponin T (cTnT) often complicates percutaneous coronary intervention (PCI). Plasma pentraxin 3 (PTX3) levels are increased in patients with arterial inflammation and especially unstable angina pectoris (UAP). This study tested whether plasma PTX3 levels can predict post-PCI cTnT elevation. MAIN METHODS We evaluated 94 consecutive patients with AP and normal pre-PCI cTnT levels who underwent PCI. Pre-PCI virtual histology-intravascular ultrasound was performed to assess culprit plaque composition. Plasma PTX3 and serum hs-CRP levels were measured pre-PCI. Patients were divided into 2 groups according to presence (Group I, n=34) or absence (Group II, n=60) of post-PCI cTnT elevation >3 × the upper limit of normal at 24h after PCI. KEY FINDINGS Plasma PTX3 (4.06 ± 2.05 ng/ml vs 2.17 ± 1.02 ng/ml, p<0.001), serum hs-CRP levels (0.25 ± 0.03 vs 0.16 ± 0.03 mg/dl, p=0.048), plaque burden (80.9 ± 5.3 vs 75.4 ± 10.6%, p=0.047), presence of positive remodeling (59 vs 25%, p=0.034), and percent necrotic core area (19.0 ± 7.4 vs 14.0 ± 5.9%, p=0.046) were significantly higher in Group I than in Group II. Receiver-operating characteristic curve analysis showed that with a best cut-off value of 2.83 ng/ml, plasma PTX3 level (AUC 0.823) predicted post-PCI cardiac TnT elevation better than did serum hs-CRP level (AUC 0.618). Multiple logistic regression analysis showed that plasma PTX3 level was the most independent predictor of post-PCI cardiac cTnT elevation (OR: 2.65; 95% CI: 1.56-10.1; p=0.003). SIGNIFICANCE Plasma PTX3 level may be a useful marker for predicting post-PCI cardiac cTnT elevation, which is associated with inflammatory status of culprit lesions.
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Affiliation(s)
- Zheng Wang
- Cardiovascular Division, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Daiki Akiyama
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taizo Kimura
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazuko Tajiri
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoya Hoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Satoshi Sakai
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Koike
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Miyauchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Zimarino M, Curzen N, Cicchitti V, De Caterina R. The adequacy of myocardial revascularization in patients with multivessel coronary artery disease. Int J Cardiol 2013; 168:1748-57. [DOI: 10.1016/j.ijcard.2013.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 04/04/2013] [Accepted: 05/03/2013] [Indexed: 02/04/2023]
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Gollop ND, Dhullipala A, Nagrath N, Myint PK. Is periprocedural CK-MB a better indicator of prognosis after emergency and elective percutaneous coronary intervention compared with post-procedural cardiac troponins? Interact Cardiovasc Thorac Surg 2013; 17:867-71. [PMID: 23842761 DOI: 10.1093/icvts/ivt303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in interventional cardiac surgery was written according to a structured protocol. The question we addressed related to the elevation of markers of cardiac damage associated with percutaneous coronary intervention (PCI). We explored and compared the clinical and prognostic relevance of the elevation of creatinine kinase-myocardial band (CK-MB) and cardiac troponin (cTn) levels during the periprocedural period and the post-procedural period, respectively, following an emergency or elective PCI. We found in excess of 390 papers after a systematic literature search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. From the best evidence available it appears that the monitoring of cardiac biomarkers following a PCI can provide important clinical information about the health of the myocardium, as well as prognostic information on short to mid-term outcomes of mortality up to 3 years. The narrow evidence base advocates the use of periprocedural CK-MB monitoring, recommending that an elevation in CK-MB is a significant predictor of adverse events. Troponins remain a precise and reliable marker of cardiac damage; however, current evidence argues that cTn holds little prognostic relevance until the degree of elevation is almost five times the upper limit of normal (ULN). Thus, the best evidence recommends the use of periprocedural CK-MB routinely during PCI to provide clinical and prognostic information about the degree of myocardial injury and risk of post-procedural morbidity and mortality.
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16
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Troponins in the definition of myocardial infarction after percutaneous coronary interventions. COR ET VASA 2013. [DOI: 10.1016/j.crvasa.2012.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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The prognosis of periprocedural myocardial infarction after percutaneous coronary interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2013; 14:32-6. [DOI: 10.1016/j.carrev.2012.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 10/16/2012] [Accepted: 10/16/2012] [Indexed: 12/24/2022]
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18
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Sethi SS, Singh A, Farkouh ME. Periprocedural myocardial enzyme elevation: prognostic implications for current practice. Curr Cardiol Rep 2012; 14:424-32. [PMID: 22673863 DOI: 10.1007/s11886-012-0288-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With the high volume of yearly cardiovascular revascularization procedures, periprocedural myocardial enzyme elevation remains an important topic. Although periprocedural myocardial enzyme elevation has been used in the universal definition of myocardial infarction, most hospitals do not routinely measure postprocedural cardiac enzymes. Multiple studies have illustrated the prognostic implications of such biomarker elevations on mortality and cardiovascular outcomes (especially in the short term), yet the question of routine marker assessments remains vexing. Heterogeneity in these studies has caused debate to continue regarding the appropriate cutoff levels, choice of biomarker assay, and situations in which markers should be measured. Along with the clinical implications of clarifying these issues, we acknowledge the impact on the management and interpretation of our large-scale, practice-altering clinical trials. In this review, we highlight significant concepts in the diagnosis, prognosis, and clinical impact of periprocedural myocardial enzyme elevation.
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Affiliation(s)
- Sanjum S Sethi
- Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029, USA
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Zimarino M, Corcos T, Bramucci E, Tamburino C. Rotational atherectomy: a "survivor" in the drug-eluting stent era. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 13:185-92. [PMID: 22522057 DOI: 10.1016/j.carrev.2012.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 03/04/2012] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
Mechanical debulking of coronary plaques with rotational atherectomy (RA) has been used for more than 20 years during percutaneous coronary interventions (PCI). Modification of plaque characteristics may be accomplished with selective ablation of inelastic fibrocalcific tissue. The use of RA, though reduced with the development of bare-metal stents (BMS) and even more with drug-eluting stents (DES), has never been completely abandoned. The present review will analyze reasons for conflicting results obtained in large series and randomized trials on this topic in the past, and will identify criteria for an appropriate use in current times.
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Affiliation(s)
- Marco Zimarino
- Institute of Cardiology and Center of Excellence on Aging, G. d'Annunzio University-Chieti, Italy.
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