European Heart Journal Advance Access originally published online on September 21, 2005
European Heart Journal 2005 26(23):2493-2519; doi:10.1093/eurheartj/ehi455
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Peri-procedural myocardial injury: 2005 update
Department of Internal Medicine, Mayo Clinic Rochester, 200 First Street S.W., Rochester, MN 55905, USA
Received 15 December 2004; revised 4 July 2005; accepted 25 July 2005; online publish-ahead-of-print 21 September 2005.
* Corresponding author. Tel: +1 507 255 5890; fax: +1 507 255 1824. E-mail address: herrmann.joerg{at}mayo.edu
During the past three decades, percutaneous coronary intervention has become one of the cardinal treatment strategies for stenotic coronary artery disease. Technical advances, including the introduction of new devices such as stents, have expanded the interventional capabilities of balloon angioplasty. At the same time, there has been a decline in the rate of major adverse cardiac events, including Q-wave acute myocardial infarction, emergency coronary artery bypass grafting, and cardiac death. Despite these advances, the incidence of post-procedural cardiac marker elevation has not substantially decreased since the first serial assessment 20 years ago. As of now, these post-procedural cardiac marker elevations are considered to represent peri-procedural myocardial injury (PMI) with worse long-term outcome potential. Recent progress has been made for the identification of two main PMI patterns, one near the intervention site (proximal type, PMI type I) and one in the distal perfusion territory of the treated coronary artery (distal type, PMI type II) as well as for preventive strategies. Integrating these new developments into the wealth of clinical information on this topic, this review aims at giving a current perspective on the entity of PMI.
Key Words: Angioplasty • Atherectomy • Cardiac troponin • Creatine kinase • Embolization • Myocardial infarction • Stents
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