Increased CK-MB Release Is a "Trade-Off" for Optimal Stent Implantation: An Intravascular Ultrasound Study

Ioannis Iakovou, Gary S. Mintz, George Dangas, Alexandre Abizaid, Roxana Mehran, Yoshio Kobayashi, Alexandra J. Lansky, Eve D. Aymong, Eugenia Nikolsky, Gregg W. Stone, Jeffrey W. Moses, Martin B. Leon

Research output: Contribution to journalArticlepeer-review

62 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1900-1905
Number of pages6
JournalJournal of the American College of Cardiology
Volume42
Issue number11
DOIs
StatePublished - 3 Dec 2003
Externally publishedYes

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