[Predictive elements and prevention of myocardial damage during angioplasty/stenting].
Cardiac enzyme elevation is observed in 5-30% of patients after percutaneous intervention and appears associated with higher subsequent cardiac events and mortality. The cause of myocardial enzyme release could be an obvious angiographic complication of the procedure but, most frequently, is neither clinically nor angiographically clear. Different clinical series have identified clinical, angiographic and procedural risk factors for CK-MB elevation after otherwise successful coronary intervention, including unstable angina, diffuse atherosclerosis and aggressive procedures such as atheroablation. Microembolization of atherothrombotic plaque material appears to be the pathogenetic mechanism. Periprocedural administration of platelet glycoprotein IIb/IIIa inhibitors has been shown to reduce subsequent myocardial infarction and long-term mortality. Beta-blockers may also have a protective effect against post-procedural CK-MB elevations and follow-up cardiac events. New distal protection devices are under investigation and appear promising. The risk of inducing myocardial damage during percutaneous intervention should be considered before attempting the procedure. The use of platelet IIb/IIIa inhibitors and protection devices should be considered in high-risk patients.
Bossi
Irene
I
I Divisione di Cardiologia, Dipartimento Cardiologico A. De Gasperis, Ospedale Niguarda Ca' Granda, Milano.
Savonitto
Stefano
S
Cavallini
Claudio
C
Delgado
Anabella
A
Pirola
Roberto
R
Klugmann
Silvio
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017225:Atherectomy, Coronary / Q000009:adverse effects / Q000379:methods; D015415:Biomarkers / Q000097:blood; D001807:Blood Vessel Prosthesis; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D004617:Embolism / Q000097:blood / Q000209:etiology; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology* / Q000517:prevention & control; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D015607:Stents / Q000009:adverse effects*
D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D007527:Isoenzymes; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form