Preprocedural hs-CRP Level Serves as a Marker for Procedure-Related Myocardial Injury During Coronary Stenting

BACKGROUND AND OBJECTIVES: Elevated hs-CRP (high sensitivity C-reactive protein) is well known as a biomarker reflecting the inflammatory process that might evoke the potential for microembolization of an atheromatous plaque, and imparts a poor prognosis in patients with coronary artery disease. We designed this study to evaluate whether the preprocedural hs-CRP level was associated with procedure-related myocardial injury following coronary stenting. SUBJECTS AND METHODS: We obtained the plasma hs-CRP level from angina patient, who underwent coronary stenting, within 24 hours prior to the procedure, and divided the patients into either the normal CRP (hs-CRP or =3 mg/L). We defined the reduction of TMP (TIMI myocardial perfusion) grade as at least one decrease in the TMP grade following coronary stenting compared with the pre-procedural TMP. We also evaluate the procedure-related myocardial damage by measuring CK-MB leakage after stenting. RESULTS: We enrolled 279 lesions in 226 patients, who were divided into two groups: the normal CRP group (n=137, 1.28+/-0.71 mg/L) and the elevated CRP group (n=89, 6.89+/-4.23 mg/L). A reduction in the TMP grade was significantly more prevalent in the elevated CRP (20 lesions, 17.4%) compared to the normal CRP group (6 lesions, 3.7%, p=0.001). An elevated CRP level was related to an increased CK-MB leakage following stenting (elevated CRP group; 23 patients, 25.8%, normal CRP group; 21 patients, 15.3%, p=0.041). In a multivariable analysis, the only significant predictor of a reduction in the TMP grade following stenting was an elevated CRP level. CONCLUSION: Systemically detectable inflammatory activity, served by the plasma hs-CRP level, is associated with procedure-related microvascular injury, as assessed by a reduction in the TMP grade and CK-MB elevation following coronary stenting.

Comparison of TIMI Myocardial Perfusion Grade with Coronary Flow Reserve for Prediction of Recovery of LV Function and LV Remodeling in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: The TIMI myocardial perfusion (TMP) grade is known as one of the methods to assess the viability of the myocardium in ischemic heart disease. This study was designed to assess the value of TMP grade itself and to evaluate the correlation with coronary flow reserve (CFR) in the prediction of left ventricular remodeling and functional change after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). SUBJECTS AND METHODS: We measured CFR and TMP grade after successful elective PCI (diameter stenosis <0%, and TIMI flow 3) in 83 patients (mean age 55+/-1 years, 18 females) with AMI within 7 days of symptom onset. Left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI), ejection fraction (LVEF), and left ventricular regional wall motion score index (LVRWMSI) were assessed by echocardiography just before and at 9 months after angioplasty (mean 9+/-5 months). RESULTS: Although they had achieved (TIMI 0.021) TIMI 3 flow after successful intervention, 27 of 83 patients (32.5%) had impaired myocardial perfusion. After PCI, angiographic TMP grade was well correlated with CFR measured using Doppler wire (TMP 0/1;1.4+/-0.3, TMP 2;1.9+/-0.6, TMP 3;2.2+/-0.4, rs=0.618, p=0.000). Post-PCI TMP grade was significantly related to the change of LVEDVI (r=0.452, p=0.000), LVESVI (r=0.435, p=0.000), LVEF (r=0.281, p=0.010) and LVRWMSI (r=0.328, p=0.036). CONCLUSION: The TMP grade, a simple angiographic method, might be useful as a predictor of LV volume and functional change in AMI. In the cardiac catheterization laboratory, it could simply replace CFR for the assessment of myocardial viability in patients who receive an elective PCI within 7 days of AMI onset.

Microvascular Integrity and Ventricular Function according to Early ST-Segment Resolution in Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Early resolution of ST-segment elevation improves the short and long-term mortalities in acute myocardial infarction (AMI). However, the correlations between the ST segment resolution and microvascular integrity, or functional recovery of the left ventricle, were not explored. SUBJECTS AND METHODS: The study population consisted of 42 AMI patients who received thrombolytic therapy (35 male, 54+/-11 years) and consecutive successful percutaneous coronary intervention (PCI) (<30% of residual stenosis, recovered TIMI 3 flow) within 7 days. The coronary flow reserve (CFR) was measured at the segment just distal to the angioplasty site using intracoronary Doppler wire following a successful PCI. Electrocardiograms (ECG) were evaluated before, and within 90-150 minutes after, of the thrombolytic therapy. The percentage change in the ST segment resolution, from the baseline to follow-up, was categorized into complete resolution (70%, n=24), partial resolution (30% to <70%, n=10) and no resolution (0% to <30%, n=8). The ejection fraction (EF) and regional wall motion score indices (RWMSI) were assessed by 2D-echocardiography before, and following the PCI (9+/-5 months). RESULTS: Complete ST segment resolution was observed in 57%, partial resolution in 24%, and no resolution in 19% of patients. The CFR was significantly higher in the complete resolution group than in the no resolution group, and the minimal coronary vascular resistance index was significantly lower in the complete resolution group than in the no resolution group (2.1+/-0.5 vs. 1.4+/-0.4, p=0.006; 2.31+/-0.99mmHg sec cm-1 vs. 3.84+/-2.19mmHg sec cm-1, p=0.035, respectively). The changes in the EF and RWMSI were significantly better in complete resolution group than in the no resolution group (10+/-9% vs. 0+/-5%, p=0.028; -1.03+/-0.50 vs. 0.24+/-0.66, p=0.004, respectively), and the left ventricular end diastolic and systolic volume indices were significantly increased in the no resolution group at follow-up (42.0+/-14.8 mL/m2 vs. 55.8+/-18.1 mL/m2, p=0.006; 23.2+/-10.9 mL/m2 vs. 30.5+/-15.9 mL/m2, p=0.039, respectively). CONCLUSION: In the AMI patients, with a recovered TIMI 3 flow, following thrombolysis and successful elective PCI, there were differences in the coronary flow reserve according to the degree of early resolution of the ST segment. The patients with an early complete resolution of the ST segment showed the most favorable preservation of the microvascular integrities and improvement of the left ventricular function. The degree of early resolution of the ST segment might be a useful indicator for the prediction of left ventricular functional changes at follow-up.