Abnormal coronary flow velocity reserve after coronary intervention is associated with cardiac marker elevation

Joerg Herrmann, Michael Haude, Amir Lerman, Rainer Schulz, Lothar Volbracht, Junbo Ge, Axel Schmermund, Heinrich Wieneke, Clemens Von Birgelen, Holger Eggebrecht, Dietrich Baumgart, Gerd Heusch, Raimund Erbel

Research output: Contribution to journalArticle

110 Scopus citations

Abstract

Background - Residual reduction of relative coronary flow velocity reserve (rCVR) after successful coronary intervention has been related to microvascular impairment. However, the incidence of cardiac enzyme elevation as a surrogate marker of an underlying embolic myocardial injury in these cases has not been studied. Methods and Results - A series of 55 consecutive patients with successful coronary stenting, periprocedural intracoronary Doppler analysis, and determination of creatine kinase (CK; upper limit of normal [ULN] for women 70 IU/L, for men 80 IU/L) and cardiac troponin T (cTnT; bedside test, threshold 0.1 ng/mL) before and 6, 12, and 24 hours after intervention were studied. Postprocedural rCVR was the only intracoronary Doppler parameter that independently correlated with cTnT (r=-0.498, P<0.001) and CK outcome (r=-0.406, P=0.002). Receiver operating characteristic analysis identified a postprocedural rCVR of 0.78 as the best discriminating value, with a sensitivity of 83.3% and 69.2% and a specificity of 79.1% and 76.2% for detection of cTnT and CK elevation, respectively. Stratified according to this cutoff value, the incidence of cTnT elevation was 52.6% in patients with (n=19) and 5.6% in patients without (n=36) a postprocedural rCVR <0.78 (P<0.001), associated with a CK elevation >1 times the ULN in 36.8% and 5.6% (P=0.005) of patients, respectively. Conclusions - Cardiac marker elevation can frequently be found after coronary procedures that are associated with a persistent reduction of rCVR, indicating procedural embolization of atherothrombotic debris with microvascular impairment and myocardial injury as a potential underlying mechanism.

Original languageEnglish (US)
Pages (from-to)2339-2345
Number of pages7
JournalCirculation
Volume103
Issue number19
DOIs
StatePublished - May 15 2001

Keywords

  • Blood flow
  • Creatine kinase
  • Myocardial infarction
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Herrmann, J., Haude, M., Lerman, A., Schulz, R., Volbracht, L., Ge, J., Schmermund, A., Wieneke, H., Von Birgelen, C., Eggebrecht, H., Baumgart, D., Heusch, G., & Erbel, R. (2001). Abnormal coronary flow velocity reserve after coronary intervention is associated with cardiac marker elevation. Circulation, 103(19), 2339-2345. https://doi.org/10.1161/01.CIR.103.19.2339