Myonecrosis Following Stent Placement: Association between Impaired TIMI Myocardial Perfusion Grade and MRI Visualization of Microinfarction

James W. Choi, C. Michael Gibson, Sabina A. Murphy, Charles J. Davidson, Raymond J. Kim, Mark J. Ricciardi*

*Corresponding author for this work

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Contrast-enhanced cardiac MRI (ceMRI) and TIMI myocardial perfusion grade analysis (TMPG) are proven methods for visualization of microinfarction and assessment of microvascular perfusion, respectively. To determine whether microvascular obstruction accounts for procedure-related myonecrosis, 14 poststent patients, 9 with procedural CK-MB elevation and 5 controls, underwent ceMRI and TMPG. All had TIMI 3 flow pre- and poststent. TMPG was normal in 12/ 14 pre- and 7/14 poststent. Those with poststent decline in TMPG had higher CK-MB (median, 41.0 vs. 7.4 ng/mL; P = 0.01) and larger infarct mass (median, 3.1 vs. 0.89 g; P = 0.04). More extensive myonecrosis (CK-MB > 3 × normal; infarct mass > 3 g) was observed more frequently if there was a poststent decline in TM PG (3/3, 100%, vs. 2/11, 18.2%; P = 0.03). These data support the theory that distal embolization and microvascular obstruction are associated with myonecrosis following otherwise successful coronary stent placement and provide further insight into its pathophysiology.

Original languageEnglish (US)
Pages (from-to)472-476
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume61
Issue number4
DOIs
StatePublished - Apr 1 2004

Keywords

  • Coronary angioplasty
  • Microcirculation
  • Myocardial infarction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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