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Myonecrosis following stent placement: Association between impaired TIMI myocardial perfusion grade and MRI visualization of microinfarction
Author(s) -
Choi James W.,
Gibson C. Michael,
Murphy Sabina A.,
Davidson Charles J.,
Kim Raymond J.,
Ricciardi Mark J.
Publication year - 2004
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20024
Subject(s) - timi , medicine , perfusion , cardiology , myocardial infarction , coronary flow reserve , stent , radiology , percutaneous coronary intervention , blood flow
Contrast‐enhanced cardiac MRI (ceMRI) and TIMI myocardial perfusion grade analysis (TMPG) are proven methods for visualization of microinfarction and assessment of microvascular perfusion, respectively. To determine whether microvascular obstruction accounts for procedure‐related myonecrosis, 14 poststent patients, 9 with procedural CK‐MB elevation and 5 controls, underwent ceMRI and TMPG. All had TIMI 3 flow pre‐ and poststent. TMPG was normal in 12/14 pre‐ and 7/14 poststent. Those with poststent decline in TMPG had higher CK‐MB (median, 41.0 vs. 7.4 ng/mL; P = 0.01) and larger infarct mass (median, 3.1 vs. 0.89 g; P = 0.04). More extensive myonecrosis (CK‐MB > 3 × normal; infarct mass > 3 g) was observed more frequently if there was a poststent decline in TMPG (3/3, 100%, vs. 2/11, 18.2%; P = 0.03). These data support the theory that distal embolization and microvascular obstruction are associated with myonecrosis following otherwise successful coronary stent placement and provide further insight into its pathophysiology. Catheter Cardiovasc Interv 2004;61:472–476. © 2004 Wiley‐Liss, Inc.