Beschreibung:
<jats:p>
<jats:italic>Background</jats:italic>
—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.
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<jats:p>
<jats:italic>Methods and Results</jats:italic>
—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 (
<jats:italic>r</jats:italic>
=−0.498,
<jats:italic>P</jats:italic>
<0.001) and CK outcome (
<jats:italic>r</jats:italic>
=−0.406,
<jats:italic>P</jats:italic>
=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 (
<jats:italic>P</jats:italic>
<0.001), associated with a CK elevation >1 times the ULN in 36.8% and 5.6% (
<jats:italic>P</jats:italic>
=0.005) of patients, respectively.
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<jats:p>
<jats:italic>Conclusions</jats:italic>
—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.
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