Anna Damascelli MD, Presenter: Nothing to Disclose

Francesco Aldo De Cobelli MD, Abstract Co-Author: Nothing to Disclose

Antonio Esposito MD, Abstract Co-Author: Nothing to Disclose

Giulia Benedetti, Abstract Co-Author: Nothing to Disclose

Paolo Guido Camici, Abstract Co-Author: Nothing to Disclose

Alessandro Del Maschio MD, Abstract Co-Author: Nothing to Disclose

Microvascular obstruction (MVO) may occur in patients with ST-Elevation Myocardial Infarction (STEMI) after percutaneous revascularization and it has been associated with a negative outcome. We evaluated the relationship between admission cardiac markers’ levels and MVO assessed by Cardiac Magnetic Resonance (CMR).

We enrolled 58 consecutive STEMI patients admitted to our ER. Patients were treated with primary percutaneous coronary intervention (PCI) and underwent CMR (1.5 T) within 5 days from the event. Blood samples were taken before any drug administration and before PCI. Troponin-T (TpnT), CK, CK-MB and pro-brain natriuretic peptide (NT-pro-BNP) were quantified. The CMR criteria of MVO were the presence of a subendocardial lack of signal within areas of enhancement in FPP-sequences and/or in early and late-enhancement sequences (5 and 15 minutes after gadolinium administration). The presence of a hypointense region within the hyperintense area of edema on STIR sequences was considered as a marker of hemorrhage. MVO and hemorrhage were quantified as a percentage of left ventricle myocardial mass.

We compared patients (age 60±10 yrs; 51 male) with and without MVO (38 and 20 respectively) and patients with and without haemorrhage (20 and 38 respectively) for cardiac markers’ levels. TpnT, CK and CK-MB peaks were significantly higher in patients with MVO (p<0.001) and there was a significant correlation between enzymatic levels and MVO extent (p<0.001). TpnT, CK, and CK-MB peaks were also significantly higher in patients with hemorrhage (p<0.001) and we found a significant correlation between enzymatic levels and hemorrhage extent (TpnT: p=0.021; CK: p=0.005 and CKMB: p=0.004). At the multivariate analysis only CK-MB resulted as an independent predictor of MVO (p=0.007). ROC curve analysis showed that patients with CK-MB ≥123 ng/ml have a higher risk of MVO after PCI (sensitivity: 94%; specificity: 84%; AUC: 0.93). Patients with MVO and hemorrhage also showed a higher level of pro-BNP (p=0.02 and p=0.017). 

These preliminary data suggest that CK-MB peaks could predict the risk of MVO in STEMI patients before PCI procedure.

MVO after PCI in STEMI patients has been associated with a negative outcome; cardiac enzyme at admission could predict MVO occurrence and may help in prevent it.

Damascelli, A, De Cobelli, F, Esposito, A, Benedetti, G, Camici, P, Del Maschio, A, Cardiac Enzyme Peaks and Pro-BNP at Admission could Predict Presence of Microvascular Obstruction at Cardiac Magnetic Resonance in Patients with ST-Elevation Myocardial Infarction..  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013919.html