Minor myocardial damage during percutaneous coronary intervention does not affect long-term prognosis.

INTRODUCTION AND OBJECTIVES: 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.

El daño miocárdico mínimo durante el intervencionismo coronario percutáneo no influye en el pronóstico a largo plazo / Minor Myocardial Damage During Percutaneous coronary intervention Does not affect long- term Prognosis

Introducción y objetivos. Evaluar el pronóstico a largo plazo del daño miocárdico producido durante el intervencionismo coronario percutáneo (ICP). Métodos. Incluimos una serie de pacientes consecutivos a quienes se practicó ICP, excluyendo a los que ya presentaban basalmente elevación de marcadores cardiacos. El ECG y los marcadores de daño miocárdico se evaluaron antes y a las 12 y 24 h tras el procedimiento. Según el valor de dichos marcadores, se clasificó a los pacientes en tres grupos: ausencia de daño miocárdico (troponina y CK-MB normal), daño miocárdico mínimo (elevación del valor de troponina, con CK-MB normal) y mionecrosis (elevación de troponina I y CK-MB). Muerte, infarto de miocardio y nueva revascularización fueron evaluados durante el seguimiento. Resultados. De 757 pacientes incluidos, en 127 (16,8%) se detectó daño miocárdico mínimo asociado al procedimiento y en 46 (6,1%) mionecrosis. Durante un seguimiento de 45 ± 14 meses, 151 (19,1%) pacientes sufrieron eventos cardiacos. Los pacientes que presentaron mionecrosis tuvieron un significativo incremento de la mortalidad durante el seguimiento (13%) respecto a los otros dos grupos (el 4,8 y el 3,9%; log rank test, 6,83; p = 0,032). No se detectaron diferencias en la tasa de IAM o nueva revascularización en el seguimiento. Conclusiones. El daño miocárdico mínimo durante el intervencionismo no influye en el pronóstico a largo plazo. Por contra, la mionecrosis se asocia a un incremento de mortalidad. Este hecho implica la necesidad de determinar la CK-MB tras todo ICP debido a su implicación pronóstica y la aplicación de estrategias que disminuyan la aparición de mionecrosis (AU)

Introduction and objectives. 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 (AU)