Low incidence of cardiac biomarker elevation following PCI of chronic total coronary occlusions.
OBJECTIVE
After a percutaneous coronary intervention (PCI) creatine kinase-MB fraction (CK-MB) elevation is observed in 5 to 30% of the cases. The often long and diffuse lesions of chronic total coronary occlusions (CTO) could represent a high risk group. However, there is no systematic data available on the incidence of elevation of cardiac troponin I (cTNI) after recanalisation of CTOs.


METHODS
In 201 patients a CTO was successfully recanalised with stenting of all lesions and the regional wall motion (WMSI) was assessed at baseline and follow-up. For comparison we analysed 111 stable angina patients with stenting of single non-occlusive lesions. Over a period of 24 hours after PCI, CK-MB and cTNI were measured.


RESULTS
CK-MB elevation after recanalisation of CTOs was observed in only 6% of patients with CTOs. The incidence of cardiac biomarker elevation was similar in patients with normal and severely impaired regional function, indicating that the low incidence was not due to a high prevalence of non-vital myocardium. In comparison CK-MB elevation after stenting of single non-occlusive lesions was observed in 13% of patients. In 14% of patients with CTOs and in 20% of patients with a single non-occlusive lesions cTNI increased after PCI.


CONCLUSIONS
Despite the high plaque load of organised thrombotic material in CTOs, the incidence of cardiac biomarker elevation after recanalisation of CTOs was similar to that after stenting of single non-occlusive lesions. A specific adjunctive medical or interventional therapy may not be warranted during recanalisation of CTOs.
Bahrmann
Philipp
P
Clinic of Internal Medicine I, Jena, Germany.
Ferrari
Markus
M
Figulla
Hans R
HR
Werner
Gerald S
GS