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Notaristefano F, Cavallini C. Atrial fibrillation and troponin elevation: It's time to give up the chase to diagnosis and step forward with prognosis. Eur J Intern Med 2022; 99:26-27. [PMID: 35140032 DOI: 10.1016/j.ejim.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 11/03/2022]
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De Servi S, Landi A. Procedural myocardial infarction and major myocardial injury after percutaneous coronary interventions in chronic coronary syndrome: Is the fog really waning? Eur J Intern Med 2022; 96:17-19. [PMID: 34802863 DOI: 10.1016/j.ejim.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 11/03/2022]
Abstract
The prognostic role of procedural myocardial infarction (MI) is still controversial and matter of ongoing debate in the scientific community. A recent ESC Consensus Document confirmed the prognostic importance of type 4a MI and defined equally clinically relevant the major peri‑procedural myocardial injury, defined as the same cardiac Troponin cut-off threshold of type 4a MI without peri‑procedural angiographic complications, electrocardiographic or imaging evidence of new myocardial ischaemia. In the present manuscript we discuss available data supporting this paradigm shift and discuss some drawbacks which should be taken into account in interpreting the results. In light of recent mounting evidence, we challenge the prognostic relevance of major periprocedural myocardial injury, suggesting that type 4a MI should be the only definition for procedural MI to be used as an endpoint in clinical trials.
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Affiliation(s)
- Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy.
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
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Prognostic Value of High Sensitive Troponin T in Patients with Chronic Ischemic Heart Disease Undergoing Percutaneous Coronary Intervention. COR ET VASA 2021. [DOI: 10.33678/cor.2020.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Silvain J, Zeitouni M, Paradies V, Zheng HL, Ndrepepa G, Cavallini C, Feldman DN, Sharma SK, Mehilli J, Gili S, Barbato E, Tarantini G, Ooi SY, von Birgelen C, Jaffe AS, Thygesen K, Montalescot G, Bulluck H, Hausenloy DJ. Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data. Eur Heart J 2021; 42:323-334. [PMID: 33257958 PMCID: PMC7850039 DOI: 10.1093/eurheartj/ehaa885] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/10/2020] [Accepted: 10/14/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated. METHODS AND RESULTS We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84-1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32-3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by the Fourth UDMI occurred in 12.7% of patients and was strongly associated with 1-year mortality [adj OR 3.21, 95% CI (1.42-7.27), P = 0.005]. We also present our results according to the type of troponin used (hs-cTn or conventional troponin). CONCLUSION Our analysis has demonstrated that in CCS patients with normal baseline cTn levels, the post-PCI cTn elevation of ≥5 × 99th percentile URL used to define Type 4a MI is associated with 1-year mortality and could be used to detect 'major' procedural myocardial injury in the absence of procedural complications or evidence of new myocardial ischaemia.
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Affiliation(s)
- Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, 47-83 bld de l’Hôpital, 75013 Paris, France
| | - Michel Zeitouni
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, 47-83 bld de l’Hôpital, 75013 Paris, France
| | - Valeria Paradies
- Cardiology Department, Maasstad Hospital, Rotterdam, Netherlands
| | - Huili L Zheng
- Health Promotion Board, National Registry of Diseases Office, Singapore, Singapore
| | - Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany
| | - Claudio Cavallini
- Division of Cardiology, Ospedale S Maria della Misericordia, Piazzale Meneghini 1, Perugia 06100, Italy
| | - Dimitri N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York, NY, USA
| | - Samin K Sharma
- Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
| | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Sze Y Ooi
- Eastern Heart Clinic, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Allan S Jaffe
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), INSERM UMRS 1166, 47-83 bld de l’Hôpital, 75013 Paris, France
| | | | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, University College London, London, UK
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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5
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Periprocedural Myocardial Injury: Pathophysiology, Prognosis, and Prevention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1041-1052. [PMID: 32586745 DOI: 10.1016/j.carrev.2020.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/27/2023]
Abstract
The definition and clinical implications of myocardial infarction occurring in the setting of percutaneous coronary intervention have been the subject of unresolved controversy. The definitions of periprocedural myocardial infarction (PMI) are many and have evolved over recent years. Additionally, the recent advancement of different imaging modalities has provided useful information on a patients' pre-procedural risk of myocardial infarction. Nonetheless, questions on the benefit of different approaches to prevent PMI and their practical implementation remain open. This review aims to address these questions and to provide a current and contemporary perspective.
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Li Y, Pei H, Bulluck H, Zhou C, Hausenloy DJ. Periprocedural elevated myocardial biomarkers and clinical outcomes following elective percutaneous coronary intervention: a comprehensive dose-response meta-analysis of 44,972 patients from 24 prospective studies. EUROINTERVENTION 2020; 15:1444-1450. [PMID: 31829942 DOI: 10.4244/eij-d-19-00737] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The optimal cut-off value of isolated cardiac biomarker elevation for defining prognostically important percutaneous coronary intervention (PCI)-related myocardial injury is not known. We performed a meta-analysis to evaluate the dose-response relationship between isolated cardiac biomarker elevations and the risk of all-cause mortality following elective PCI. METHODS AND RESULTS Twenty-four prospective studies (44,972 patients) were included. Patients with an isolated elevation of cardiac biomarkers had an increased risk of all-cause mortality when compared to those with no elevations (cardiac troponin I: odds ratio [OR] 1.42, 95% confidence interval [CI]: 1.19-1.69; creatine kinase-MB isoenzyme [CK-MB]: OR 1.43, 95% CI: 1.19-1.70). For the dose-response analysis, elevations of cardiac troponin I >3x or CK-MB >1x the 99th percentile upper reference limit (URL) were associated with increased mortality (cardiac troponin I: OR 1.51, 95% CI: 1.05-2.17; CK-MB: OR 1.25, 95% CI: 1.05-1.48). The pooled OR of mortality for each 3xURL increment of cardiac troponin I or CK-MB was 1.33 (95% CI: 1.15-1.53) and 1.38 (95% CI: 1.30-1.47). CONCLUSIONS We found that a positive dose-response relationship between isolated cardiac troponin I and CK-MB with all-cause mortality and elevated cardiac troponin I >3x or CK-MB >1x the 99th percentile URL was associated with an increased risk of mortality.
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Affiliation(s)
- Yuehua Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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7
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Impact of periprocedural biomarker elevation on mortality in stable angina pectoris patients undergoing elective coronary intervention: a systematic review and meta-analysis including 24 666 patients. Coron Artery Dis 2020; 31:137-146. [DOI: 10.1097/mca.0000000000000795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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8
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Health Economic Evaluation of an Ultrathin, Bioresorbable-Polymer Sirolimus-Eluting Coronary Stent Compared to a Thin, Durable-Polymer Everolimus-Eluting Stent. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:752-757. [DOI: 10.1016/j.carrev.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/22/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
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9
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Lippi G, Mattiuzzi C, Sanchis-Gomar F. Routine cardiac troponin assessment after percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2019; 20:495-499. [DOI: 10.2459/jcm.0000000000000826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Sanuki Y, Sonoda S, Muraoka Y, Inoue K, Setoyama K, Miura T, Shimizu A, Anai R, Miyamoto T, Oginosawa Y, Tsuda Y, Araki M, Otsuji Y. Impact of High-Sensitivity Cardiac Troponin Elevation in Relation to Diagnostic Invasive Intravascular Imaging for the Assessment of Coronary Artery Disease. Int Heart J 2019; 60:601-607. [PMID: 31105151 DOI: 10.1536/ihj.18-448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recent studies reported that cardiac troponin elevation after percutaneous coronary intervention is related to adverse cardiac events. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are often used to assess lesion characteristics in the coronary arteries. However, little is known about the trend of cardiac troponin elevation after diagnostic invasive intracoronary examination and the prognostic influence. We assessed the relationship between myocardial injury manifested by the high-sensitivity cardiac troponin T (hs-cTnT) level after invasive intracoronary examination and future adverse cardiac outcomes. We evaluated 115 patients with stable coronary artery disease who underwent IVUS or OCT for detailed coronary assessment during coronary angiography (CAG). Baseline and post-procedural (within 24 hours after examination) hs-cTnT were measured. In consequence, post-procedural hs-cTnT level and percentage increase were higher in patients with IVUS or OCT during CAG than in those without. Periprocedural myocardial injury (PMI, defined as post-procedural hs-cTnT with upper reference limit greater than five-fold) occurred in 10 (8.6%) patients. There were no significant differences in baseline characteristics between patients with and without PMI, except for left-ventricular diastolic dimension. Only two major adverse cardiac events (MACE, defined as cardiovascular death, nonfatal myocardial infarction, and target lesion revascularization) occurred in non-PMI during a mean observation period of 32 ± 18 months. On Kaplan-Meier analysis, MACE-free survival rate was similar between PMI and non-PMI. In conclusion, a few imperceptible PMI derived by hs-cTnT assay occurred after diagnostic invasive intracoronary examination. However, it was not associated with subsequent poor cardiac outcome.
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Affiliation(s)
- Yoshinori Sanuki
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Shinjo Sonoda
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Yoshitaka Muraoka
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Konosuke Inoue
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Koshi Setoyama
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Toshiya Miura
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Akiyoshi Shimizu
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Reo Anai
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Tetsu Miyamoto
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Yasushi Oginosawa
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Yuki Tsuda
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Masaru Araki
- Second Department of Internal Medicine, University of Occupational and Environmental Health
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health
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11
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Abstract
"Periprocedural myocardial infarction (MI) occurs infrequently in the current era of percutaneous coronary interventions (PCI) and is associated with an increased risk of mortality and morbidity. Periprocedural MI can occur due to acute side branch occlusion, distal embolization, slow flow or no reflow phenomenon, abrupt vessel closure, and nonidentifiable mechanical processes. Therapeutic strategies to reduce the risk of periprocedural MI include dual antiplatelet therapy, intravenous cangrelor in the periprocedural setting, intravenous glycoprotein IIb/IIIa inhibitor in high-risk patients, anticoagulation with unfractionated heparin, low-molecular-weight heparin or bivalirudin, and embolic protection devices during saphenous vein graft interventions."
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Affiliation(s)
- David W Lee
- Division of Interventional Cardiology, University of North Carolina, 160 Dental Circle, CB 7075, Chapel Hill, NC 27599, USA.
| | - Matthew A Cavender
- Division of Interventional Cardiology, University of North Carolina, 160 Dental Circle, CB 7075, Chapel Hill, NC 27599, USA
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12
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Ben-Yehuda O, Chen S, Redfors B, McAndrew T, Crowley A, Kosmidou I, Kandzari DE, Puskas JD, Morice MC, Taggart DP, Leon MB, Lembo NJ, Brown WM, Simonton CA, Dressler O, Kappetein AP, Sabik JF, Serruys PW, Stone GW. Impact of large periprocedural myocardial infarction on mortality after percutaneous coronary intervention and coronary artery bypass grafting for left main disease: an analysis from the EXCEL trial. Eur Heart J 2019; 40:1930-1941. [DOI: 10.1093/eurheartj/ehz113] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/04/2018] [Accepted: 03/06/2019] [Indexed: 01/06/2023] Open
Affiliation(s)
- Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | - Ioanna Kosmidou
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
| | | | - John D Puskas
- Mount Sinai Heart at Mount Sinai Saint Luke’s, New York, NY, USA
| | | | - David P Taggart
- Department Cardiac Surgery, John Radcliffe Hospital, Oxford, UK
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Nicholas J Lembo
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | | | | - Ovidiu Dressler
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
| | | | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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13
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Predictive value of baseline C-reactive protein for periprocedural myocardial infraction of higher risk stratifications: A retrospective cohort clinical study. Anatol J Cardiol 2018; 20:310-317. [PMID: 30297597 PMCID: PMC6287438 DOI: 10.14744/anatoljcardiol.2018.05406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: It is controversial whether preprocedural elevated high sensitivity C-reactive protein (CRP) could increase the incidence of periprocedural myocardial infraction (PMI) of higher risk stratifications. The primary aim of this study was to evaluate whether preoperative elevated CRP level was related to the incidence of PMI in patients who underwent percutaneous coronary intervention (PCI). Methods: A total of 4.426 patients [66 y (59, 75); 72.3% males] with normal preprocedural cardiac enzymes were prospectively divided into two groups; the elevated CRP group was defined as CRP >3 mg/L, which was approximately 30.4% of the patients. The relationship between CRP and the incidence of PMI was established by multivariate logistic regression analysis, and multivariate linear regression analysis was used to assess the correlation between CRP and the severity of myocardial injury. Results: The incidence rates were similar between the two groups with periprocedural myocardial minor necrosis (34.23% versus 32.74%, p=0.607), but significantly differed based on the 2007 (defined as cardiac enzymes >3-fold elevations), 31.25% in high CRP group versus 26.25% in low group [odds ratio (OR) 1.19; p=0.046] and the 2012 universal PMI (defined as cardiac enzymes >5-fold elevations with at least one clinical evidence, such as chest pain, ECG changes or imaging diagnosis of heart ischemia), 19.79% versus 15.35% (OR 1.26, p=0.023); besides, the PMI ratios increased in line with the elevation of CRP (p=0.006 for the 2007 and p=0.011 for the 2012 universal PMI). However, no significant linear relationship was found between CRP and high sensitivity cardiac troponin I peak post-PCI. Conclusion: Elevated baseline CRP was an independent risk factor for the incidence of the 2007 and the 2012 universal PMI rather than minor necrosis. However, CRP may not correlate with the severity of minor myocardial necrosis in patients with PMI.
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Yamaji K, Brugaletta S, Sabaté M, Iñiguez A, Jensen LO, Cequier A, Hofma SH, Christiansen EH, Suttorp M, van Es GA, Sotomi Y, Onuma Y, Serruys PW, Windecker S, Räber L. Effect of Post-Dilatation Following Primary PCI With Everolimus-Eluting Bioresorbable Scaffold Versus Everolimus-Eluting Metallic Stent Implantation: An Angiographic and Optical Coherence Tomography TROFI II Substudy. JACC Cardiovasc Interv 2018; 10:1867-1877. [PMID: 28935079 DOI: 10.1016/j.jcin.2017.07.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study sought to investigate the effect of post-dilatation on angiographic and intracoronary imaging parameters in the setting of primary percutaneous coronary intervention comparing the everolimus-eluting bioresorbable scaffold (BRS) with the everolimus-eluting metallic stent (EES). BACKGROUND Routine post-dilatation of BRS has been suggested to improve post-procedural angiographic and subsequent device-related clinical outcomes. METHODS In the ABSORB STEMI TROFI II trial, 191 patients with ST-segment elevation myocardial infarction were randomly assigned to treatment with BRS (n = 95) or EES (n = 96). Minimal lumen area and healing score as assessed by optical coherence tomography at 6 months were compared between BRS- and EES-treated patients stratified according to post-dilatation status. RESULTS Primary percutaneous coronary intervention with post-dilatation was performed in 48 (50.5%) BRS- and 25 (25.5%) EES-treated lesions. There were no differences in baseline characteristics and post-procedural minimal lumen diameter between groups. In the BRS group, lesions with post-dilatation were associated with a trend toward a smaller minimal lumen area at 6 months (5.07 ± 1.68 mm2 vs. 5.72 ± 1.77 mm2; p = 0.09) and significantly larger angiographic late lumen loss (0.28 ± 0.34 mm vs. 0.12 ± 0.25 mm; p = 0.02), whereas no difference was observed in the EES arm (5.46 ± 2.18 mm2 vs. 5.55 ± 1.77 mm2; p = 0.85). The neointimal healing score was low and comparable between groups with and without post-dilation (BRS: 1.55 ± 2.61 vs. 1.92 ± 2.17; p = 0.48; EES: 2.50 ± 3.33 vs. 2.90 ± 4.80; p = 0.72). CONCLUSIONS In the setting of selected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with BRS or EES, post-dilatation did not translate into larger lumen area or improved arterial healing at follow-up. (ABSORB STEMI: The TROFI II; NCT01986803).
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Affiliation(s)
- Kyohei Yamaji
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Salvatore Brugaletta
- Thorax Institute, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Manel Sabaté
- Thorax Institute, University Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Gerrit Anne van Es
- Cardialysis B.V., Rotterdam, the Netherlands; European Cardiovascular Research Institute, Rotterdam, the Netherlands
| | - Yohei Sotomi
- The Heart Center, Academic Medical Center, Amsterdam, the Netherlands
| | - Yoshinobu Onuma
- Cardialysis B.V., Rotterdam, the Netherlands; Thorax Centre, Erasmus MC, Rotterdam, the Netherlands
| | - Patrick W Serruys
- International Center for Circulatory Health, NHLI, Imperial College, London, United Kingdom
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland.
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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15
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Lee T, Murai T, Isobe M, Kakuta T. Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with non-ST segment elevation acute coronary syndrome. Catheter Cardiovasc Interv 2017; 90:905-914. [PMID: 28303685 DOI: 10.1002/ccd.27037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/26/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to use optical coherence tomography (OCT) to study the relationship between plaque morphology prior to percutaneous coronary intervention (PCI) and post-PCI cardiac troponin (cTn) elevations in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Furthermore, the relationship between these findings and the adverse cardiac events during follow-up was assessed. BACKGROUND Association between post-PCI cTn elevations and OCT findings in NSTE-ACS patients is unclear. METHODS We evaluated 167 patients with stable or falling cTn values after admission who underwent PCI. Periprocedural myocardial injury (PMI) was defined as an cTn increase of more than 70× upper limit of normal (ULN) in troponin-negative patients before PCI, or more than new 70× ULN elevation from the previous nadir level in pre-PCI troponin-positive patients. Clinical and OCT findings were compared between patients with (n = 48, 29%) and without (n = 119, 71%) PMI. RESULTS PMI was associated with age, prior PCI, low estimated glomerular filtration rate (eGFR), OCT-derived thin-cap fibroatheroma (TCFA), plaque rupture, and lipid length. In multivariable analysis, TCFA (odds ratio [OR], 2.88; P = 0.011), eGFR (OR, 0.97, P = 0.003), and lipid length (OR, 1.12, P = 0.020) were independent predictors of PMI. At a median follow-up of 38 months, event-free survival was significantly worse in patients with PMI (log-rank test χ2 = 6.47, P = 0.011). CONCLUSIONS OCT analysis showed that PMI occurs more frequently in lesions with TCFA in NSTE-ACS patients, and may identify patients having a higher risk of adverse cardiac events during follow-up. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Tetsumin Lee
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.,Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tadashi Murai
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Mitsuaki Isobe
- Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
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16
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Vieira de Melo RM, Hueb W, Nomura CH, Ribeiro da Silva EE, Villa AV, Oikawa FTC, da Costa LMA, Rezende PC, Garzillo CL, Lima EG, Franchini Ramires JA, Kalil Filho R. Biomarker release after percutaneous coronary intervention in patients without established myocardial infarction as assessed by cardiac magnetic resonance with late gadolinium enhancement. Catheter Cardiovasc Interv 2017; 90:87-93. [DOI: 10.1002/ccd.27125] [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] [Received: 12/20/2016] [Revised: 04/05/2017] [Accepted: 04/23/2017] [Indexed: 12/24/2022]
Affiliation(s)
| | - Whady Hueb
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Cesar Higa Nomura
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | - Alexandre Volney Villa
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | | | - Paulo Cury Rezende
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Cibele Larrosa Garzillo
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | - Eduardo Gomes Lima
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
| | | | - Roberto Kalil Filho
- Department of Atherosclerosis; Heart Institute (InCor) of the University of São Paulo; São Paulo SP Brazil
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17
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Ndrepepa G, Colleran R, Braun S, Xhepa E, Hieber J, Cassese S, Fusaro M, Kufner S, Laugwitz KL, Schunkert H, Kastrati A. Comparative prognostic value of postprocedural creatine kinase myocardial band and high-sensitivity troponin T in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2017; 91:215-223. [DOI: 10.1002/ccd.27105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Gjin Ndrepepa
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
| | - Roisin Colleran
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
| | - Siegmund Braun
- Department of Laboratory Medicine; Deutsches Herzzentrum München, Technische Universität; Munich Germany
| | - Erion Xhepa
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
| | - Julia Hieber
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
| | - Salvatore Cassese
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
| | - Massimiliano Fusaro
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
| | - Sebastian Kufner
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
| | - Karl-Ludwig Laugwitz
- 1.Medizinische Klinik, Klinikum rechts der Isar, Technische Universität; Munich Germany
- Partner Site Munich Heart Alliance; DZHK (German Centre for Cardiovascular Research); Munich Germany
| | - Heribert Schunkert
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
- Partner Site Munich Heart Alliance; DZHK (German Centre for Cardiovascular Research); Munich Germany
| | - Adnan Kastrati
- Department of Adult Cardiology; Deutsches Herzzentrum München, Technische Universität; Munich Germany
- Partner Site Munich Heart Alliance; DZHK (German Centre for Cardiovascular Research); Munich Germany
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18
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Abstract
This review examines the rationale for using remote ischemic conditioning (RIC) in elective percutaneous coronary intervention (PCI) to prevent procedure-related ischemia-reperfusion injury and justifies the importance of periprocedural biomarker elevation following elective PCI as a valid target for RIC. We review the evidence for the use of RIC as a treatment in this setting and document the salutary rules that must be followed to successfully translate RIC for clinical benefit.
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Affiliation(s)
- Joel P Giblett
- 1 Department of Interventional Cardiology, Papworth Hospital, Papworth Everard, Cambridge, UK
| | - Stephen P Hoole
- 1 Department of Interventional Cardiology, Papworth Hospital, Papworth Everard, Cambridge, UK
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19
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Ducrocq G, Schulte PJ, Budaj A, Cornel JH, Held C, Himmelmann A, Husted S, Storey RF, Cannon CP, Becker RC, James SK, Katus HA, Lopes RD, Sorbets E, Wallentin L, Steg PG. Balancing the risk of spontaneous ischemic and major bleeding events in acute coronary syndromes. Am Heart J 2017; 186:91-99. [PMID: 28454837 DOI: 10.1016/j.ahj.2017.01.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/20/2017] [Indexed: 01/23/2023]
Abstract
Evaluation of antithrombotic treatments for acute coronary syndromes (ACS) requires balancing ischemic and bleeding risks to assess net benefit. We sought to compare the relative effects of ischemic and bleeding events on mortality. METHODS In the PLATelet inhibition and patient Outcomes (PLATO) trial, we compared spontaneous ischemic events (myocardial infarction or stroke) with spontaneous major bleeding events (PLATO major, Thrombolysis In Myocardial Infarction [TIMI] major, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO] severe) with respect to risk of mortality using time-dependent Cox proportional hazards models. The comparison was performed using ratio of hazard ratios for mortality increase after ischemic vs bleeding events. RESULTS A total of 822 patients (4.4%) had ≥1 spontaneous ischemic event; 485 patients (2.6%), ≥1 spontaneous PLATO major bleed, 282 (1.5%), ≥1 spontaneous TIMI major bleed; and 207 (1.1%), ≥1 spontaneous severe GUSTO bleed. In patients who had both events, bleeding occurred first in most patients. Regardless of classification, major bleeding events were associated with increased short- and long-term mortality that were not significantly different from the increase associated with spontaneous ischemic events: ratio of hazard ratios (95% CIs) for short- and long-term mortality after spontaneous ischemic vs bleeding events: 1.46 (0.98-2.19) and 0.92 (0.52-1.62) (PLATO major); 1.26 (0.80-1.96) and 1.19 (0.58-2.24) (TIMI major), 0.72 (0.47-1.10) and 0.83 (0.38-1.79) (GUSTO severe) (all P>0.05) CONCLUSIONS: In patients with ACS on dual antiplatelet therapy, spontaneous major bleeding events seem "prognostically equivalent" to spontaneous ischemic complications. This result allows quantitative comparisons between both actual and predicted bleeding and ischemic risks. Our findings help to better define net clinical benefit of antithrombotic treatments and more accurately estimate mortality after ischemic and bleeding events in patients with ACS.
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Affiliation(s)
- Gregory Ducrocq
- FACT (French Alliance for Cardiovascular Trials), Paris, France; Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France; INSERM-Unité 1148, Paris, France.
| | - Phillip J Schulte
- Duke Clinical Research Institute, Duke University, Medical Center, Durham, NC; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Andrzej Budaj
- Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
| | - Jan H Cornel
- Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Claes Held
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | - Steen Husted
- Medical Department, Hospital Unit West, Herning/Holstebro, Denmark
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, and Baim Institute for Clinical Research Boston, MA
| | - Richard C Becker
- Division of Cardiovascular Health and Disease, Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Stefan K James
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Hugo A Katus
- Medizinishe Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University, Medical Center, Durham, NC
| | - Emmanuel Sorbets
- FACT (French Alliance for Cardiovascular Trials), Paris, France; Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; INSERM-Unité 1148, Paris, France; Hôpital Avicenne (Assistance Publique-Hôpitaux de Paris), and Université Paris 13, Bobigny, France
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Trials), Paris, France; Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France; INSERM-Unité 1148, Paris, France; NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK
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20
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Yang X, Tamez H, Lai C, Ho K, Cutlip D. Type 4a myocardial infarction: Incidence, risk factors, and long-term outcomes. Catheter Cardiovasc Interv 2016; 89:849-856. [PMID: 27535209 DOI: 10.1002/ccd.26688] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/17/2016] [Accepted: 07/02/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the incidence of and outcomes related to periprocedural (Type 4a) myocardial infarction (MI) in a cohort of patients undergoing percutaneous coronary intervention (PCI) for stable coronary disease or non ST-elevation acute coronary syndrome with stable or falling cardiac troponin levels. BACKGROUND The 2012 Third Universal Definition for Type 4a MI has not been prospectively studied in routine clinical practice. METHODS The study included 516 patients undergoing eligible PCI at a single institution. Data were extracted from the National Cardiovascular Data Registry, review of electronic medical records, and telephone interviews. Clinical outcomes assessed at one year included all-cause mortality, recurrent MI, or any repeat coronary revascularization. RESULTS Based on the Third Universal Definition of MI, 53 (10.3%) patients met criteria for Type 4a MI and 116 (22.5%) had myocardial injury. The Type 4a MI and myocardial injury groups each had significantly higher numbers of stents, longer stent lengths, and more use of rotational atherectomy than the control group. Type 4a MI was not associated with one-year mortality. The composite endpoint of death or recurrent MI at one year was similar between the Type 4a MI and myocardial injury groups (12 vs. 11%; P > 0.05), which were both higher compared with the control group (3%; P = 0.02, 0.03). CONCLUSIONS Type 4a MI and myocardial injury were frequent, and were associated with more complicated index PCI and more frequent death or recurrent MI at one year as compared with the control group. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Xiaoyu Yang
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hector Tamez
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Carol Lai
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kalon Ho
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Donald Cutlip
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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21
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Adamson PD, Mills NL. Peri-procedural Myocardial Infarction: If You Don't Take a Temperature, You Can't Find a Fever. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:725-9. [PMID: 27425123 DOI: 10.1016/j.rec.2016.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Philip D Adamson
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicholas L Mills
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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22
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Adamson PD, Mills NL. Infarto de miocardio periintervención: si no se mira la temperatura, no se puede detectar la fiebre. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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Christensen MK, Huang H, Torp-Pedersen C, Trydal T, Ravkilde J. Incidence and impact on prognosis of peri-procedural myocardial infarction in 2760 elective patients with stable angina pectoris in a historical prospective follow-up study. BMC Cardiovasc Disord 2016; 16:140. [PMID: 27305902 PMCID: PMC4910200 DOI: 10.1186/s12872-016-0293-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The clinical significance of myocardial infarction related to treatment with percutaneous coronary intervention (PCI) has been subject of great discussion. This subject has been studied for many years using different definitions of peri-procedural myocardial infarction and different biomarkers, the results have varied greatly depending on methods and time of the study. This study was to determine the incidence and prognostic significance of elevated cardiac biomarkers after elective PCI in patients with stable angina pectoris using the current cut-off set by the Third Universal Definition of Myocardial Infarction and current biomarkers. METHODS We performed a historical prospective follow-up study of all patients with stable angina pectoris who underwent elective PCI at Aalborg University Hospital, Denmark from January 1(st) 2000 to December 31(st) 2012. We stratified patients according to peak post-PCI troponin T (cTnT) and Creatine Kinase MB mass (CK-MBmass). RESULTS Follow-up for time to all-cause mortality was mean 5.8 years and total 15,891 years and mean 3.7 years and total 10,160 years for the combined endpoint of all-cause mortality and new onset heart failure. During the follow up period 399 of 2760 patients died (14.5 %) and 1095 (39.7 %) suffered the combined endpoint. Post-PCI concentration of cTnT and CK-MBmass was elevated above the defined cut-off in 419 patients (15.2 %) and 113 patients (4.1 %) respectively. There was no statistically significant difference between the groups in stratified analysis of the hazard rates by time regarding all-cause mortality for cTnT nor CK-MBmass. Regarding the combined endpoint the results were ambiguous. The results were unchanged in multivariable analyses that included age and gender. CONCLUSION The incidence of elevated biomarkers after elective PCI in patients with stable angina pectoris using the defined cut-off (>5 x URL) was 15.2 % using cTnT and 4.1 % using CK-MBmass. The independent prognostic value for both cardiac biomarkers of any cut-off showed no statistical significance for all-cause mortality, whereas the combined endpoint (all-cause mortality or new-onset heart failure) were ambiguous in both short- and long-term follow-up.
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Affiliation(s)
| | - Hui Huang
- General Hospital of Ningxia Medical University, Yinchuan, China and Visiting Doctor at Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Torleif Trydal
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Sarkisian L, Saaby L, Poulsen TS, Gerke O, Hosbond S, Jangaard N, Diederichsen ACP, Thygesen K, Mickley H. Prognostic Impact of Myocardial Injury Related to Various Cardiac and Noncardiac Conditions. Am J Med 2016; 129:506-514.e1. [PMID: 26763756 DOI: 10.1016/j.amjmed.2015.12.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Elevated cardiac troponins in clinical conditions other than myocardial infarction are well known. For such occurrences, the term "myocardial injury" has been proposed. The long-term outcome in patients with myocardial injury related to various cardiac and noncardiac clinical disorders is unknown. METHODS During January 2010 to January 2011, we prospectively studied hospitalized patients who had cardiac troponin I measured on clinical indication. Patients with cardiac troponin I values >30 ng/L and no evidence of myocardial ischemia were diagnosed as having myocardial injury. Patients were classified into 5 categories of plausible related conditions: cardiac ischemic, cardiac nonischemic, noncardiac, multifactorial, or indeterminate. Follow-up was a minimum of 3 years, with all-cause mortality as the single end-point. RESULTS A total of 3762 patients were considered, of whom 1089 (29%) had myocardial injury. The most common associated conditions were noncardiac (n = 346) or multifactorial (n = 359). Cardiac ischemic (n = 183) and cardiac nonischemic (n = 134) conditions occurred less frequently. After a median of 3.2 years, 645 patients (59%) had died. A multivariate Cox regression analysis showed no difference in mortality between patients with cardiac ischemic and cardiac nonischemic conditions (hazard ratio [HR] 0.75; 95% confidence interval [CI], 0.50-1.13; P = .2). Patients with noncardiac or multifactorial disorders, however, had significantly higher mortality than those with associated cardiac ischemic conditions (HR 1.39; 95% CI, 1.06-1.80; P = .02, and HR 1.94; 95% CI, 1.50-2.51; P <.001), respectively. CONCLUSIONS In patients with myocardial injury, the most common associated conditions were noncardiac or multifactorial. Of notice, these patients had significantly higher long-term mortality when compared with those with associated cardiac conditions.
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Affiliation(s)
- Laura Sarkisian
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lotte Saaby
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Tina S Poulsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Centre of Health Economics Research, University of Southern Denmark, Odense, Denmark
| | - Susanne Hosbond
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Nikolaj Jangaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
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Sato A, Aonuma K. Coronary plaque morphology on multi-modality imagining and periprocedural myocardial infarction after percutaneous coronary intervention. IJC HEART & VASCULATURE 2016; 11:43-48. [PMID: 28616524 PMCID: PMC5441347 DOI: 10.1016/j.ijcha.2016.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 03/04/2016] [Indexed: 11/17/2022]
Abstract
Percutaneous coronary intervention (PCI) may be complicated by periprocedural myocardial infarction (PMI) as manifested by elevated cardiac biomarkers such as creatine kinase (CK)-MB or troponin T. The occurrence of PMI has been shown to be associated with worse short- and long-term clinical outcome. However, recent studies suggest that PMI defined by biomarker levels alone is a marker of atherosclerosis burden and procedural complexity but in most cases does not have independent prognostic significance. Diagnostic multi-modality imaging such as intravascular ultrasound, optical coherence tomography, coronary angioscopy, near-infrared spectroscopy, multidetector computed tomography, and magnetic resonance imaging can be used to closely investigate the atherosclerotic lesion in order to detect morphological markers of unstable and vulnerable plaques in the patients undergoing PCI. With the improvement of technical aspects of multimodality coronary imaging, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology and patients outcomes. There were numerous published data regarding the relationship between pre-PCI lesion subsets on multi-modality imaging and post-PCI biomarker levels. In this review, we discuss the relationship between coronary plaque morphology estimated by invasive or noninvasive coronary imaging and the occurrence of PMI. Furthermore, this review underlies that the value of the multimodality coronary imaging approach will become the gold standard for invasive or noninvasive prediction of PMI in clinical practice. Periprocedural myocardial infarction (PMI) has been shown to be associated with worse short- and long-term clinical outcome. Clinical practice and research are increasingly shifting toward the plaque morphology and patients outcomes. This review discusses the relationship between plaque morphology estimated by coronary imaging and the occurrence of PMI. This review underlies the value of the multimodality coronary imaging approach for prediction of PMI in clinical practice.
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Affiliation(s)
- Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan
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Auguadro C, Scalise F, Manfredi M, Casali V, Novelli E, Specchia G. The prognostic role of troponin I elevation after elective percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2016; 16:149-55. [PMID: 25010505 DOI: 10.2459/jcm.0000000000000058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the prognostic role of isolated troponin I (TnI) elevation after elective percutaneous coronary intervention (PCI) in patients with stable coronary artery disease. BACKGROUND The prognostic role of minor troponin elevation after PCI is controversial. METHODS A total of 1532 consecutive patients who underwent elective PCI were included. Follow-up data were obtained for 1432 of 1532 (93.4%) patients. The events taken into account in the follow-up included total mortality, cardiac death, hospitalization for acute myocardial infarction and/or unstable angina. RESULTS The following variables were identified as predictive of major adverse cardiac events (MACE) by univariate analysis: age 75 years at least (P = 0.012), ejection fraction less than 50% (P = 0.001), prior myocardial infarction (P = 0.031) and TnI 1.0 ng/ml at least after PCI (P = 0.04). The Cox-regression model identified the TnI elevation after PCI, the older age and the ejection fraction as independent predictors of MACE during follow-up (TnI: P = 0.042; older age: P = 0.001; ejection fraction: P = 0.003). In a subgroup of patients with preserved ejection fraction, the incidence of MACE was significantly higher in those with TnI of at least 1.0 ng/ml at least than in the ones with TnI less than 1.0 ng/ml, with the highest incidence among the older cohort. The multivariate analysis confirmed the TnI elevation 1.0 ng/ml at least after PCI and the older age as predictors of MACE. CONCLUSION This study documented that in clinically stable patients, minor TnI elevations after elective PCI are independent predictors of MACE during follow-up, as are older age and reduced ejection fraction. Additionally, TnI elevation was a predictor of MACE during follow-up in a subset of patients with preserved ejection fraction. The combination of TnI elevation and older age confers the highest risk of MACE.
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Affiliation(s)
- Carla Auguadro
- aCardiovascular Catheterization Laboratory, Policlinico di Monza bBiostatistics Unit, Policlinico di Monza cDepartment of Cardiology, Policlinico di Monza, Monza, Italy
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dos Santos Ferreira CE, França CN, Helfenstein Fonseca FA. Why not use a high-sensitivity troponin assay as an end point in clinical trials? Am J Med 2015; 128:e29. [PMID: 25812645 DOI: 10.1016/j.amjmed.2014.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022]
Affiliation(s)
| | - Carolina Nunes França
- Federal University of São Paulo, Brazil; University of Santo Amaro, São Paulo, Brazil
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Chen SL, Zhang JJ, Ye F, Tian NL, Sheiban I, Jepson N, Paiboon C, Sansoto T, Kwan TW, Wen SY, Wang HC, Jiang TM, Wang Y, Chen LL, Qiu CG, Zhang YJ, Chen MX, De Maria A. Periprocedural myocardial infarction is associated with increased mortality in patients with coronary artery bifurcation lesions after implantation of a drug-eluting stent. Catheter Cardiovasc Interv 2015; 85 Suppl 1:696-705. [PMID: 25631678 DOI: 10.1002/ccd.25857] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/07/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Shao-Liang Chen
- Cardiology, Nanjing First Hospital, Nanjing Medical University; Nanjing China
| | | | - Fei Ye
- Cardiology, Nanjing Heart Center; Nanjing China
| | - Nai-Liang Tian
- Cardiology, Nanjing First Hospital, Nanjing Medical University; Nanjing China
| | - Imad Sheiban
- Cardiology, San Giovanni Battista Hospital, University of Turin; Turin Italy
| | - Nigel Jepson
- Cardiology, Hospital of Prince Wales; Sydney Australia
| | | | - Teugh Sansoto
- Cardiology, Medistra Hospital, University of Indonesia Medical School; Indonesia
| | - Tak W. Kwan
- Cardiology, Mount Sinai Beth Israel Hospital; New York New York
| | - Shang-Yu Wen
- Cardiology, Daqing Oil General Hospital; Daqing China
| | - Hai-Chang Wang
- Cardiology, Xijing Hospital; Xi'an 4th Military Medical University; Xi'an China
| | - Tie-Ming Jiang
- Cardiology, Tianjing Policemen Medical College Hospital; Tianjing China
| | - Yan Wang
- Cardiology, Xia'Men Zhongshan Hospital; Xia'men China
| | | | - Chun-Guang Qiu
- Cardiology, Henan Provincial People's Hospital; Zhenzhou China
| | | | - Meng-Xuan Chen
- Cardiology, Emory College of Art and Science; Atlanta Georgia
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Bedair TM, Cho Y, Park BJ, Joung YK, Han DK. Coating defects in polymer-coated drug-eluting stents. BIOMATERIALS AND BIOMECHANICS IN BIOENGINEERING 2014. [DOI: 10.12989/bme.2014.1.3.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gili S, D'Ascenzo F, Moretti C, Omedè P, Vilardi I, Bertaina M, Biondi Zoccai G, Sheiban I, Stone GW, Gaita F. Impact on prognosis of periprocedural myocardial infarction after percutaneous coronary intervention. J Interv Cardiol 2014; 27:482-90. [PMID: 25175019 DOI: 10.1111/joic.12143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Different definitions of periprocedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) have been provided, but their impact on prognosis remains to be determined. METHODS Procedural data from consecutive patients undergoing PCI from 2009 to 2011 were revised to adjudicate diagnosis of periprocedural MI according to CK-MB increase (>3 × URL and >5 × URL), to troponin increase (>3 × 99th percentile URL and >5 × 99th percentile URL) and to recent 2012 Task Force and Society for Cardiovascular Angiography and Interventions (SCAI) definitions. Major adverse cardiovascular events (MACE) was the primary end-point. RESULTS Seven hundred twelve patients were enrolled; after 771 days, 115 (16.7%) patients experienced MACE. One hundred ninety patients were diagnosed with a periprocedural MI defined as elevation of troponin >5 × 99th percentile of URL. When adjudicating 2012 Task Force definition on these patients, 46 were excluded and 1.4% of them experienced a MACE and 0.3% died, while among 144 with periprocedural MI, 2.9% reported a MACE and 1.3% died. After appraisal of SCAI definition, 176 patients were excluded, 3.8% of them with a MACE and 1.4% died, and for those with periprocedural MI, 0.5% experienced a MACE and 0.1% died. Similar low performance was appraised after reclassification of patients from more than 3 of upper limit of CK-MB and of troponin. At multivariate analysis, none of these definitions related to adverse events. CONCLUSION Periprocedural MI represents a frequent complication for patients undergoing PCI. All present definitions share a still not satisfactory discrimination between patients with and without adverse events at follow-up, stressing the need for more accurate definitions.
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Affiliation(s)
- Sebastiano Gili
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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Herrmann J, Lennon RJ, Jaffe AS, Holmes DR, Rihal CS, Prasad A. Defining the Optimal Cardiac Troponin T Threshold for Predicting Death Caused by Periprocedural Myocardial Infarction After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2014; 7:533-42. [DOI: 10.1161/circinterventions.113.000544] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joerg Herrmann
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - Ryan J. Lennon
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - Allan S. Jaffe
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - David R. Holmes
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - Charanjit S. Rihal
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
| | - Abhiram Prasad
- From the Division of Cardiovascular Diseases and Department of Internal Medicine and Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN (J.H., R.J.L., A.S.J., D.R.H., C.S.R.); and Cardiac Research Centre, St George’s, University of London, London, United Kingdom (A.P.)
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Zhang M, He H, Wang ZM, Xu Z, Zhou N, Tao Z, Chen B, Li C, Zhu T, Yang D, Wang L, Yang Z. Diagnostic and prognostic value of minor elevated cardiac troponin levels for percutaneous coronary intervention-related myocardial injury: a prospective, single-center and double-blind study. J Biomed Res 2014; 28:98-107. [PMID: 24683407 PMCID: PMC3968280 DOI: 10.7555/jbr.28.20130124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/17/2013] [Accepted: 12/29/2013] [Indexed: 12/16/2022] Open
Abstract
Cardiac troponin-I (cTnI) and -T (cTnT) are sensitive and specific markers of myocardial injury. However, the role of increased cTnI and cTnT in percutaneous coronary intervention (PCI)-related myocardial injury remains controversial. In this prospective, single-center and double-blind study, we aimed to determine the diagnostic and prognostic value of cTnI as well as cTnT (cTns) in PCI-related myocardial injury in a Chinese population. A total of 1,008 patients with stable angina pectoris and non-ST-segment elevation acute coronary syndrome were recruited. The levels of cTnI and cTnT were examined before and after PCI. All patients were followed up for 26±9 months to observe the incidence of major adverse cardiac events (MACEs). Our results showed that post-PCI cTnI and/or cTnT levels were increased to more than the 99th percentile upper reference limit (URL) in 133 (13.2%) patients, among which 22 (2.2%) were more than 5 × 99th percentile URL. By univariate analysis, an elevation in cTns after PCI was not an independent predictor of increased MACEs, HR 1.35 (P = 0.33, 95%CI: 0.74–2.46). In conclusion, our data demonstrate that the incidence of PCI-related myocardial injury is not common in a Chinese population and minor elevated cTns levels may not be a sensitive prognostic marker for MACEs.
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Affiliation(s)
- Min Zhang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Huiwei He
- Department of Geriatrics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Ze-Mu Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhihui Xu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Ningtian Zhou
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhengxian Tao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Bo Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Chunjian Li
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Tiebing Zhu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Di Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Liansheng Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhijian Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China; ; Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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Grobben RB, Nathoe HM, Januzzi JL, van Kimmenade RRJ. Cardiac markers following cardiac surgery and percutaneous coronary intervention. Clin Lab Med 2014; 34:99-111, vii. [PMID: 24507790 DOI: 10.1016/j.cll.2013.11.013] [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] [Indexed: 10/25/2022]
Abstract
Differentiation between procedure-related necrosis and postprocedural myocardial infarction (MI) is challenging because of the inherent association of these procedures to varying levels of myocardial injury. To improve risk stratification of patients at risk of an acute MI, the universal definition of MI implemented cardiac biomarker thresholds. The cutoff points for these thresholds, however, are largely arbitrary and lack therapeutic implications. Measurement of cardiac marker concentrations after percutaneous coronary intervention and cardiac surgery should, therefore, be used as a marker of baseline risk, atherosclerosis burden, and procedural complexity rather than a conclusive marker to diagnose acute MI.
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Affiliation(s)
- Remco B Grobben
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - James L Januzzi
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI). J Am Coll Cardiol 2013; 62:1563-70. [PMID: 24135581 DOI: 10.1016/j.jacc.2013.08.720] [Citation(s) in RCA: 485] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 12/22/2022]
Abstract
Numerous definitions have been proposed for the diagnosis of myocardial infarction (MI) after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention (PCI)-related MI (type 4a) and coronary artery bypass grafting (CABG)-related MI (type 5), which are of uncertain prognostic importance. In addition, for both the MI types, cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK-MB. Widespread adoption of a MI definition not clearly linked to subsequent adverse events such as mortality or heart failure may have serious consequences for the appropriate assessment of devices and therapies, may affect clinical care pathways, and may result in misinterpretation of physician competence. Rather than using an MI definition sensitive for small degrees of myonecrosis (the occurrence of which, based on contemporary large-scale studies, are unlikely to have important clinical consequences), it is instead recommended that a threshold level of biomarker elevation which has been strongly linked to subsequent adverse events in clinical studies be used to define a "clinically relevant MI." The present document introduces a new definition for "clinically relevant MI" after coronary revascularization (PCI or CABG), which is applicable for use in clinical trials, patient care, and quality outcomes assessment.
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Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: An expert consensus document from the society for cardiovascular angiography and interventions (SCAI). Catheter Cardiovasc Interv 2013; 83:27-36. [DOI: 10.1002/ccd.25135] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 11/09/2022]
Affiliation(s)
| | - Lloyd W. Klein
- Division of Cardiology, Department of Medicine; Rush University; Chicago Illinois
| | - Binita Shah
- Division of Cardiology; New York University School of Medicine; New York
| | | | | | | | | | | | | | - Gregg W. Stone
- Columbia University Medical Center, New York Presbyterian Hospital and The Cardiovascular Research Foundation; New York City New York
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HODKINSON EMILYC, RAMSEWAK ADESH, MURPHY JOHNCONLETH, SHAND JAMESA, MCCLELLAND ANTHONYJ, MENOWN IANBA, HANRATTY COLMG, SPENCE MARKS, WALSH SIMONJ. An Audit of Outcomes After Same-Day Discharge Post-PCI in Acute Coronary Syndrome and Elective Patients. J Interv Cardiol 2013; 26:570-7. [DOI: 10.1111/joic.12065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - ADESH RAMSEWAK
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | | | - JAMES A. SHAND
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - ANTHONY J. MCCLELLAND
- Craigavon Cardiac Centre; Craigavon Area Hospital, Southern Health and Social Care Trust; Craigavon UK
| | - IAN B. A. MENOWN
- Craigavon Cardiac Centre; Craigavon Area Hospital, Southern Health and Social Care Trust; Craigavon UK
| | - COLM G. HANRATTY
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - MARK S. SPENCE
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
| | - SIMON J. WALSH
- Cardiology Department; Belfast Health and Social Care Trust; Belfast UK
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Niccoli G, Sgueglia GA, Latib A, Crea F, Colombo A. Association of baseline C-reactive protein levels with periprocedural myocardial injury in patients undergoing percutaneous bifurcation intervention: a CACTUS study subanalysis. Catheter Cardiovasc Interv 2013; 83:E37-44. [PMID: 23813627 DOI: 10.1002/ccd.25102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 06/04/2013] [Accepted: 06/20/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To assess the predictive value of C-reactive protein (CRP) on periprocedural myocardial injury (PMI), evaluated by creatine kinase-myocardial band isoform (CK-MB) elevation in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for the treatment of coronary bifurcation lesions is actually unknown. BACKGROUND Systemic inflammation as assessed by CRP has been associated with averse events after DES implantation. After PCI, the occurrence of PMI is common and has also been associated with worse outcomes. Finally, bifurcations are frequently encountered anatomically complex lesions which the treatment is associated with higher complication rate compared with simple lesions. METHODS A total of 96 patients (66 ± 10 years, 70 men) from the Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents (CACTUS) trial who had baseline CRP dosage and both baseline and postprocedural CK-MB measurement were included. RESULTS A complex bifurcation strategy was implemented in 53 (55%) patients, and angiographic success was achieved in all but two (2%) patients. Periprocedural myocardial necrosis (increase of CK-MB between one and three times the upper limit of normal [ULN]) was observed in 12 (13%) patients, and four (4%) patients had PCI-related myocardial infarction (increase of CK-MB more than three times ULN). Notably, progressively higher CRP levels were observed in patients with different increase in CK-MB (P = 0.041). Moreover, CRP >1 mg/L significantly predicted CK-MB rise (odds ratio 5.6, 95% confidence interval 1.5-4.3, P = 0.011). CONCLUSION In the setting of true coronary bifurcations treated by DES, baseline CRP levels were significantly associated with both the incidence and the extent of PMI.
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Affiliation(s)
- Giampaolo Niccoli
- Institute of Cardiology, Università Cattolica Del Sacro Cuore, Rome, Italy
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Akinina SA. PERIPROCEDURAL MYOCARDIAL DAMAGE. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2013. [DOI: 10.15829/1728-8800-2013-1-95-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Percutaneous coronary intervention (PCI), as a method of myocardial revascularisation, is widely and effectively used for the treatment of coronary heart disease (CHD), with immediate success rates of >90%. Depending on the diagnostic criteria, 5–30% of these patients could develop the signs of periprocedural myocardial damage (PMD) or periprocedural myocardial infarction (PMI). PMD predictors, mechanisms of PMD development, and its specific clinical features play an important role in the PMI prevention. At present, there is no universal agreement on the definition and diagnostics of periprocedural myocardial necrosis and PMI, or on their impact on the clinical outcomes. According to the results of the recent studies, which are presented in this review, the current criteria of PMI might need to be modified, due to the increasingly high sensitivity of the modern threshold levels of troponin.
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Affiliation(s)
- S. A. Akinina
- Khanty-Mansiysk Autonomous District — Yugra, District Clinical Hospital, Khanty-Mansiysk
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Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BR, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, López-Sendón JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Bøtker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR. Documento de consenso de expertos. Tercera definición universal del infarto de miocardio. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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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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Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third Universal Definition of Myocardial Infarction. Glob Heart 2012; 7:275-95. [DOI: 10.1016/j.gheart.2012.08.001] [Citation(s) in RCA: 257] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BR, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow JJ, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasche P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Botker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60:1581-98. [PMID: 22958960 DOI: 10.1016/j.jacc.2012.08.001] [Citation(s) in RCA: 2240] [Impact Index Per Article: 186.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark.
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Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. Third universal definition of myocardial infarction. Nat Rev Cardiol 2012. [PMID: 22922597 DOI: 10.1038/nrcardio2012.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark.
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Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Katus HA, Lindahl B, Morrow DA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S. Third universal definition of myocardial infarction. Circulation 2012; 126:2020-35. [PMID: 22923432 DOI: 10.1161/cir.0b013e31826e1058] [Citation(s) in RCA: 2374] [Impact Index Per Article: 197.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Kristian Thygesen
- Department of Cardiology, Aarhus University Hospital, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark.
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Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Thygesen K, Alpert JS, White HD, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman BA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S. Third universal definition of myocardial infarction. Eur Heart J 2012; 33:2551-67. [PMID: 22922414 DOI: 10.1093/eurheartj/ehs184] [Citation(s) in RCA: 2115] [Impact Index Per Article: 176.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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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, Cicchitti V, Genovesi E, Rotondo D, De Caterina R. Isolated troponin increase after percutaneous coronary interventions: Does it have prognostic relevance? Atherosclerosis 2012; 221:297-302. [DOI: 10.1016/j.atherosclerosis.2011.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 10/06/2011] [Accepted: 10/10/2011] [Indexed: 10/16/2022]
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Pervaiz MH, Sood P, Sudhir K, Hermiller JB, Hou L, Hattori K, Su X, Cao S, Wang J, Applegate RJ, Kereiakes DJ, Yaqub M, Stone GW, Cutlip DE. Periprocedural Myocardial Infarction in a Randomized Trial of Everolimus-Eluting and Paclitaxel-Eluting Coronary Stents. Circ Cardiovasc Interv 2012; 5:150-6. [DOI: 10.1161/circinterventions.111.965566] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M. Hassan Pervaiz
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Poornima Sood
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Krishnankutty Sudhir
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - James B. Hermiller
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Liming Hou
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Kyoko Hattori
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Xiaolu Su
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Sherry Cao
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - John Wang
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Robert J. Applegate
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Dean J. Kereiakes
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Manejeh Yaqub
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Gregg W. Stone
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
| | - Donald E. Cutlip
- From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (M.H.P., D.E.C.); Abbott Vascular, Santa Clara, CA (P.S., K.S., L.H., K.H., X.S., S.C., M.Y.); St Vincent's Heart Center of Indiana, Indianapolis, IN (J.B.H.); Union Memorial Hospital, Baltimore, MD (J.W.); Wake Forest University Health Sciences, Winston-Salem, NC (R.J.A.); The Christ Hospital Heart and Vascular Center/The Lindner Center, Cincinnati, OH (D.J.K.); Columbia University Medical Center/New
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