AJM onlineClinical research studyIncidence and Predictors of Cardiomyocyte Injury in Elective Coronary Angiography
Section snippets
Patients
Consecutive stable patients scheduled to undergo elective coronary angiography at the University Hospital Basel, Switzerland, in 2012 and 2013 were assessed prospectively with a quality assurance program to document the incidence of periprocedural cardiomyocyte injury. High-sensitivity cardiac troponin measurements were performed twice: before and after undergoing coronary angiography. Patient flow is illustrated in Figure 1. Patients were included in this analysis if the high-sensitivity
Baseline Characteristics
The baseline characteristics, medical history, and echocardiographic findings of 749 patients with and without periprocedural cardiomyocyte injury are shown in Table 1. The mean age was 68 years, and approximately one third of the patients were female. Patients with periprocedural cardiomyocyte injury were older, were more often women, were more likely to have atrial fibrillation and aortic valve stenosis, and had greater left ventricular ejection fraction. We observed more documented
Discussion
This study used the extensively validated high-sensitivity cardiac troponin assay11, 12, 13, 16 and predefined high-sensitivity cardiac troponin change criteria18, 19 to investigate the incidence and predictors of periprocedural cardiomyocyte injury after elective coronary angiography. We report 4 findings that provide novel insights regarding iatrogenic harm induced during elective coronary angiography and challenge the current concept that periprocedural myocardial infarction/injury is a rare
Conclusions
Our findings should not be misinterpreted to indicate that coronary angiography would be a dangerous procedure. In contrast, our study confirms large previous registries showing that coronary angiography is safe and only rarely associated with clinically apparent adverse events. This study used the most sensitive in vivo method to detect and quantify subclinical cardiomyocyte injury (high-sensitivity cardiac troponin assays) to obtain insights that should help to further increase patient safety
Acknowledgment
The authors thank the patients who participated in the study, the staff of the cardiac ward, and the laboratory technicians (particularly Michael Freese, Claudia Stelzig, Irina Klimmeck, Kathrin Meissner, Janine Voegele, Beate Hartmann, and Fausta Chiaverio) for their valuable efforts.
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Funding: This study was supported by the Cardiovascular Research Foundation Basel and the University Hospital Basel.
Conflict of Interest: MR has received speakers honoraria from Abbott. TR has received research grants from the Swiss National Science Foundation (PASMP3-136995), the Swiss Heart Foundation, the University of Basel, the Professor Max Cloetta Foundation, and the Department of Internal Medicine, University Hospital Basel, as well as speakers honoraria from Brahms and Roche. CM has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, Abbott, AstraZeneca, Beckman Coulter, Biomerieux, BRAHMS, Roche, Siemens, Singulex, Sphingotec, and the University Hospital Basel, as well as speaker/consulting honoraria and/or travel support from Abbott, ALERE, AstraZeneca, Bayer, BG Medicine, Biomerieux, BMS, BRAHMS, Cardiorentis, Daiichi Sankyo, Eli-Lilly, Novartis, Roche, Siemens, and Singulex. All other authors declare that they have no conflict of interest with this study. The sponsors had no role in the design of the study, the analysis of the data, the preparation of the manuscript, or the decision to submit the manuscript for publication.
Authorship: All authors had access to the data and played a role in writing this manuscript.