Prognostic value of coronary revascularisation-related myocardial injury: a cardiac magnetic resonance imaging study
- K Rahimi1,
- A P Banning2,
- A S H Cheng3,
- T J Pegg4,
- T D Karamitsos4,
- K M Channon2,
- S Darby1,
- D P Taggart5,
- S Neubauer6,
- J B Selvanayagam7
- 1University of Oxford, Clinical Trial Service Unit and Epidemiological Studies Unit, Oxford, UK
- 2John Radcliffe Hospital, Department of Cardiology, Oxford, UK
- 3University of Oxford, Department of Cardiovascular Medicine, Centre for Clinical Magnetic Resonance Research, Oxford, UK
- 4University of Oxford, Department of Cardiovascular Medicine, Oxford, UK
- 5University of Oxford, Nuffield Department of Surgery, Oxford, UK
- 6The University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
- 7Flinders University of South Australia, Flinders Medical Centre, Department of Cardiovascular Medicine, Adelaide, Australia
- Correspondence to Professor Joseph Selvanayagam, Flinders University of South Australia, Director Cardiac MR and CT, Flinders Medical Centre, Adelaide 5042, Australia;
- Accepted 4 August 2009
- Published Online First 16 August 2009
Aims: Myocardial revascularisation improves outcomes in patients with coronary artery disease. However, these procedures may themselves cause irreversible myocardial injury. The prognostic value of procedural myocardial injury is uncertain.
Methods and results: We quantified procedural myocardial necrosis using delayed enhancement cardiovascular magnetic resonance imaging (DE-CMR) in 152 consecutive patients before and shortly after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The primary endpoint was defined as death, non-fatal myocardial infarction, sustained ventricular arrhythmia, unstable angina or heart failure requiring hospitalisation. During a median follow-up of 2.9 years, 27 patients (18%) reached the primary endpoint. 49 patients (32%) had evidence of new procedure-related myocardial hyperenhancement with a median mass of 5.0 g (interquartile range 2.7–9.8). After adjustment for age and sex, these patients had a 3.1-fold (95% confidence interval 1.4 to 6.8; p = 0.004) higher risk of adverse outcome than patients without new hyperenhancement. Cardiac troponin levels and quantitative measures of left ventricular function after procedure did not show any significant independent association with the primary endpoint and they did not alter the independent association of new hyperenhancement.
Conclusions: Myocardial injury during PCI or CABG, identified by DE-CMR, adversely affects clinical outcome. This suggests the benefits from revascularisation could partially be offset by new myocardial injury caused by the intervention itself.
Funding This work was supported by the British Heart Foundation (BHF), the UK Medical Research Council (MRC) and Cancer Research UK (CRUK). SN and APB are partially funded by the Oxford Biomedical Research Centre. The funding agencies had no influence on data analysis, their interpretation or publication of the results.
Competing interests SN has received a research grant from Siemens.
Provenance and peer review Not commissioned; externally peer reviewed.
Ethics approval The study was approved by our institutional ethics committee and informed written consent was obtained from each patient.