Minor myocardial damage during percutaneous coronary intervention does not affect long-term prognosis.
OBJECTIVE
To determine whether long-term prognosis is affected by myocardial damage taking place during percutaneous coronary intervention (PCI).


METHODS
The study included consecutive patients undergoing PCI. Those with elevated baseline cardiac marker levels were excluded. Cardiac markers were evaluated and an ECG was recorded before and 12 and 24 hours after PCI. Patients were divided into three groups after PCI according to their cardiac marker levels: no myocardial damage (i.e. normal troponin and creatine kinase MB fraction [CK-MB]), minor damage (elevated troponin with normal CK-MB), and myonecrosis (elevated troponin and CK-MB). The occurrence of death, myocardial infarction or repeat revascularization during follow-up was recorded.


RESULTS
Minor myocardial damage associated with PCI was observed in 127 (16.8%) of the 757 patients included in the study and myonecrosis, in 46 (6.1%). During a follow-up of 45+/-14 months, cardiac events occurred in 151 (19.1%) patients. Mortality during follow-up was significantly higher in patients with myonecrosis (13%) than in the other two groups (4.8% and 3.9%; log rank, 6.83; P=.032). No difference was observed in the rate of myocardial infarction or repeat revascularization during follow-up.


CONCLUSIONS
Minor myocardial damage during PCI had no effect on long-term prognosis. In contrast, myonecrosis was associated with increased mortality. Consequently, the CK-MB level should be measured after all PCIs because of its prognostic implications, and strategies for reducing the risk of myonecrosis developing should be implemented.
Gómez-Hospital
Joan A
JA
Unidad de Cardiología Intervencionista, Servicio de Cardiología, IDIBELL, Hospital Universitario de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España. 26587jgh@comb.cat
Cequier
Angel
A
Valero
José
J
González-Costello
José
J
Mañas
Pilar
P
Iràculis
Emili
E
Teruel-Gila
Luis M
LM
Maristany
Jaume
J
Pascual
Marcos
M
Jara
Francesc
F
Esplugas
Enrique
E
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers; D003402:Creatine Kinase / Q000378:metabolism; D004562:Electrocardiography; D005260:Female; D006334:Heart Function Tests; D006335:Heart Injuries / Q000150:complications* / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007431:Intraoperative Complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D016019:Survival Analysis
D015415:Biomarkers; D003402:Creatine Kinase