Portal de Periódicos da CAPES

Artigo Produção Nacional Revisado por pares

BIBTEX RIS

Release of biomarkers compared with cardiac magnetic resonance for the diagnosis of procedure-related myocardial injury. A prospective trial using the third definition of myocardial infarction

2013; Oxford University Press; Volume: 34; Issue: suppl 1 Linguagem: Inglês

10.1093/eurheartj/eht308.p913

1522-9645

Leandro Menezes Alves da Costa, Whady Hueb, Rodrigo M Vieira de Melo, Fernando T Oikawa, Paulo Cury Rezende, César Higa Nomura, A. V. Villa, Célia Maria Cássaro Strunz, José Antônio Franchini Ramires, Roberto Kalil Filho,

Coronary Interventions and Diagnostics

Background: The elevation of cardiac biomarkers after percutaneous interventions (PCI) or coronary artery bypass grafting (CABG) is frequent. However, the correlation between the release and the diagnosis of procedure-related myocardial infarction (MI) remains unknown, especially after the emergence of high-sensitive troponin assays. In this study we aim to compare the release of cardiac biomarkers after mechanical interventions with the presence of new late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) and interpret these findings based on the third Task Force definitions for MI. Methods: We prospectively studied 79 patients with stable multivessel coronary artery disease and preserved ventricular function with formal indication for mechanical revascularization. Measurements of biomarkers such as high-sensitive troponin I (cTnI) and creatine kinase (CKMB) was systematically obtained before and after the procedure, six, twelve, 24, and 36 hours to PCI and until 72 hours to CABG. Furthermore, CMR and LGE was performed in all patients before and after procedures. The diagnosis of procedure-related myocardial injury was defined as up to 5 times and 10 times the 99th percentile, for PCI and CABG, respectively. Results: Of 79 patients studied, 58 (73.4%) underwent CABG and 21 (26.6%) underwent PCI. Using the Task Force definitions, for CABG patients, myocardial injury occurred in 55 (94.8%) with TnI and 14 (24.1%) with CKMB. For PCI patients, myocardial injury occurred in 14 (66.7%) with troponin and 1 (4.8%) with CKMB. 16 (20,3%) patients had new LGE on post procedure CMR, 15 (25.8%) after CABG and 1 (4.7%) after PCI. With the currents cutoffs, TnI has a sensitivity of 100% and specificity of 7.3% for CABG and a sensitivity of 100% and specificity of 5% for PCI. CKMB has a sensitivity of 53.3% and specificity of 85.4% for CABG and a sensitivity of 100% and specificity of 100% for PCI. Based on the receiver operating characteristic (ROC) curve, for CABG patients, the best cutoff of TnI was 3.38 ng/mL (85 times the 99th percentile) with a sensitivity of 80% and specificity of 66%, and of CKMB was 22.8 ng/mL (5 times the 99th percentile) with sensitivity of 73% and specificity of 64%. Conclusion: In this sample, compared with LGE in CMR, CKMB reached better accuracy than cTnl for the diagnosis of myocardial injury. These data suggest a higher troponin cutoff for the diagnosis of procedure-related MI.