title: Increased CK-MB release is a "trade-off" for optimal stent implantation: an intravascular ultrasound study.
abstract: OBJECTIVE
  We sought to determine the impact of aggressive stent expansion on creatine kinase-MB isoenzyme (CK-MB) release and clinical restenosis.
  
  
  BACKGROUND
  Elevation of CK-MB after percutaneous coronary interventions has been associated with late mortality.
  
  
  METHODS
  We identified 989 consecutive patients who underwent intravascular ultrasound-guided stenting of 1,015 coronary lesions. Patients were divided into three groups according to stent expansion, defined as the ratio of final lumen over the reference lumen cross-sectional areas: Group 1 (ratio <70%, n = 117 patients with 126 lesions); Group 2 (ratio 70% to 100%, n = 551 patients with 562 lesions); Group 3 (ratio >100%, n = 321 patients with 327 lesions).
  
  
  RESULTS
  The peak CK-MB values increased significantly with increasing stent expansion: CK-MB = 3 to 5x normal occurred 16%, 18%, and 25% in Groups 1, 2, and 3, respectively, p = 0.02; CK-MB >5 times normal occurred 9%, 13%, and 16% respectively, p = 0.02. Conversely, at one year follow-up there was a stepwise decrease in target lesion revascularization (11% vs. 19% and 17%, respectively, p = 0.04) and major adverse cardiac events with increasing stent expansion. In addition, there was a trend toward lower mortality in Group 3 (9% vs. 4.4% vs. 4.0%, p = 0.07).
  
  
  CONCLUSIONS
  Intravascular ultrasound-guided stent overexpansion (final lumen greater than reference lumen cross-sectional area) is accompanied by a higher periprocedural CK-MB release but a lower target lesion revascularization and a trend toward lower mortality at one year. Increased periprocedural CK-MB release appears as a trade-off for optimal stent implantation and lower clinical restenosis.
authors.affiliation: Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York 10022, USA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Eve D
authors.initials: ED
authors.lastname: Aymong
authors.forename: Eugenia
authors.initials: E
authors.lastname: Nikolsky
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D002932:Cineangiography; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology; D003402:Creatine Kinase / Q000378:metabolism*; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy; D019919:Prosthesis Implantation; D015607:Stents / Q000009:adverse effects; D018084:Ultrasonography, Interventional
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form