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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Increased CK-MB release is a "trade-off" for optimal stent implantation

an intravascular ultrasound study

^* Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, New York, USA

Manuscript received March 19, 2003; revised manuscript received June 1, 2003, accepted June 3, 2003.

^* Reprint requests and correspondence: Dr. George Dangas, Lenox Hill Heart and Vascular Institute, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022, USA.
gdangas{at}crf.org

This study was presented at the 52nd Annual Scientific Session of the American College of Cardiology, Atlanta, Georgia, March 2002.

OBJECTIVES: We sought to determine the impact of aggressive stent expansion on creatine kinase-MB isoenzyme (CK-MB) release and clinical restenosis.

BACKGROUND: Elevation of CK-MB after percutaneous coronary interventions has been associated with late mortality.

METHODS: We identified 989 consecutive patients who underwent intravascular ultrasound-guided stenting of 1,015 coronary lesions. Patients were divided into three groups according to stent expansion, defined as the ratio of final lumen over the reference lumen cross-sectional areas: Group 1 (ratio <70%, n = 117 patients with 126 lesions); Group 2 (ratio 70% to 100%, n = 551 patients with 562 lesions); Group 3 (ratio >100%, n = 321 patients with 327 lesions).

RESULTS: The peak CK-MB values increased significantly with increasing stent expansion: CK-MB = 3 to 5x normal occurred 16%, 18%, and 25% in Groups 1, 2, and 3, respectively, p = 0.02; CK-MB >5 times normal occurred 9%, 13%, and 16% respectively, p = 0.02. Conversely, at one year follow-up there was a stepwise decrease in target lesion revascularization (11% vs. 19% and 17%, respectively, p = 0.04) and major adverse cardiac events with increasing stent expansion. In addition, there was a trend toward lower mortality in Group 3 (9% vs. 4.4% vs. 4.0%, p = 0.07).

CONCLUSIONS: Intravascular ultrasound-guided stent overexpansion (final lumen greater than reference lumen cross-sectional area) is accompanied by a higher periprocedural CK-MB release but a lower target lesion revascularization and a trend toward lower mortality at one year. Increased periprocedural CK-MB release appears as a trade-off for optimal stent implantation and lower clinical restenosis.

Abbreviations and Acronyms   CK-MB = creatine kinase-MB isoenzyme   CSA = cross-sectional area   EEM = external elastic membrane   IVUS = intravascular ultrasound   MACE = multiple adverse cardiac events   MI = myocardial infarction   PCI = percutaneous coronary intervention   TLR = target lesion revascularization

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