Does diagnostic coronary angiography induce significant coronary microembolization in stable, ischemic patients? A prospective study.
BACKGROUND
Although microembolization during percutaneous coronary interventions is a frequent event, the extent of possible microembolization during diagnostic coronary angiography is unknown. The aim of the study was to investigate whether diagnostic coronary angiography results in coronary microembolization and consequent subtle, subclinical myocardial necrosis with enzyme elevations.


METHODS
Fifty-three consecutive patients underwent diagnostic coronary angiography due to inducible ischemia. Creatine kinase MB isoenzyme (CK MB) and cardiac troponin I (cTnI) were used as sensitive surrogate markers of myocardial necrosis. Serial measurements, before, and 6 and 24 hours following a diagnostic procedure, were performed.


RESULTS
Baseline cTnI was below the limits of detection in all patients (<0.20 ng/mL), except for one patient with 1.31 ng/mL. Baseline median CK-MB was 1.05 ng/mL (interquartile range, 0.80-1.56 ng/mL) (Fig. 1). Both at 6 and 24 hours, no patients had any increase in cTnI, with the exception of a minor increase to 0.22 ng/mL at 24 hours in one patient. At 6 hours, 25 patients had decreases in CK MB, while 22 had increases (exact P = 0.77). At 24 hours, 26 patients had decreases in CK MB and 19 patients had increases.


CONCLUSIONS
Detectable embolization with subsequent subclinical myonecrosis is an unlikely event.
Katritsis
Demosthenes
D
Department of Cardiology, Athens Euroclinic, Athens, Greece. dkatritsis@euroclinic.gr
Korovesis
Socrates
S
Karvouni
Evangelia
E
Giazitzoglou
Eleftherios
E
Paxinos
George
G
Haliassos
Alexander
A
D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects*; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology*; D052279:Creatine Kinase, MB Form / Q000097:blood; D004617:Embolism / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000000981:diagnostic imaging*; D009336:Necrosis / Q000097:blood / Q000209:etiology; D011446:Prospective Studies; D012107:Research Design; D019210:Troponin I / Q000097:blood
D019210:Troponin I; D052279:Creatine Kinase, MB Form