title: Myocardial injury following coronary artery surgery versus angioplasty (MICASA): a randomised trial using biochemical markers and cardiac magnetic resonance imaging.
abstract: OBJECTIVE
  To compare the frequency and extent of Troponin I and late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) defined injury following PCI compared with CABG in patients with multivessel and/or left main coronary artery disease (CAD), and interpret these finding in light of the new ESC/ACCF/AHA/WHF Task Force definitions for necrosis and infarction.
  
  
  RESULTS
  Prospective, registered, single centre randomised controlled trial. Eighty patients with 3 vessel CAD (≥ 50% stenoses), or 2 vessel CAD including a type C lesion in the LAD, and/or left main disease were enrolled. Mean SYNTAX and EuroSCOREs were similar for both groups. Forty patients underwent PCI with drug eluting stents and 39 underwent CABG (one died prior to CABG). In the PCI group 6/38 (15.8%) patients had LGE, compared with 9/32 (28.1%) CABG patients (p = 0.25). Using the new Task Force definitions, necrosis occurred in 30/40 (75%) PCI patients and 35/35 (100%) CABG patients (p = 0.001), whilst infarction occurred in 30/40 (75%) PCI patients and 9/32 (28.1%) CABG patients (p = 0.0001).
  
  
  CONCLUSIONS
  Periprocedural necrosis according to the Task Force definition was significantly lower in the PCI group, and universal in the CABG group. The incidence and extent of CMR defined infarction following PCI did not differ compared with CABG. This demonstrates that PCI can achieve revascularisation in complex patients without increased procedural myocardial damage.
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK. william.vargaal@nh.org.au
authors.forename: William J
authors.initials: WJ
authors.lastname: van Gaal
authors.forename: Jayanth R
authors.initials: JR
authors.lastname: Arnold
authors.forename: Luca
authors.initials: L
authors.lastname: Testa
authors.forename: Theo
authors.initials: T
authors.lastname: Karamitsos
authors.forename: Chris C S
authors.initials: CC
authors.lastname: Lim
authors.forename: Francis A
authors.initials: FA
authors.lastname: Ponnuthurai
authors.forename: Steffen
authors.initials: S
authors.lastname: Petersen
authors.forename: Jane M
authors.initials: JM
authors.lastname: Francis
authors.forename: Joseph
authors.initials: J
authors.lastname: Selvanayagam
authors.forename: Rana
authors.initials: R
authors.lastname: Sayeed
authors.forename: Nicholas
authors.initials: N
authors.lastname: West
authors.forename: Steve
authors.initials: S
authors.lastname: Westaby
authors.forename: Stefan
authors.initials: S
authors.lastname: Neubauer
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Banning
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D054855:Drug-Eluting Stents; D004562:Electrocardiography; D004739:England; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D019210:Troponin I; D052279:Creatine Kinase, MB Form