Author + information
- Received March 19, 2003
- Revision received June 1, 2003
- Accepted June 3, 2003
- Published online December 3, 2003.
- Ioannis Iakovou, MD*,
- Gary S Mintz, MD*,
- George Dangas, MD, PhD*,* (, )
- Alexandre Abizaid, MD*,
- Roxana Mehran, MD*,
- Yoshio Kobayashi, MD*,
- Alexandra J Lansky, MD*,
- Eve D Aymong, MD, MSc*,
- Eugenia Nikolsky, MD*,
- Gregg W Stone, MD*,
- Jeffrey W Moses, MD* and
- Martin B Leon, MD*
- ↵*Reprint requests and correspondence:
Dr. George Dangas, Lenox Hill Heart and Vascular Institute, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022, USA.
This study was presented at the 52nd Annual Scientific Session of the American College of Cardiology, Atlanta, Georgia, March 2002.
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 5× 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.
- Received March 19, 2003.
- Revision received June 1, 2003.
- Accepted June 3, 2003.
- American College of Cardiology Foundation