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Clinical research study
Incidence and Predictors of Cardiomyocyte Injury in Elective Coronary Angiography

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Abstract

Objective

Coronary angiography is considered to be a safe tool for the evaluation of coronary artery disease and performed in approximately 12 million patients each year worldwide. The aim of our study was to investigate the frequency and predictors of cardiomyocyte injury in patients undergoing elective coronary angiography.

Methods

A total of 749 consecutive patients who were scheduled to undergo elective coronary angiography were prospectively analyzed. High-sensitivity cardiac troponin T concentrations were measured both before and after elective coronary angiography (without intervention). Acute cardiomyocyte injury was predefined as an absolute increase in high-sensitivity cardiac troponin T of at least 7 ng/L (if also fulfilling a relative change of >20%).

Results

Acute cardiomyocyte injury was observed in 101 patients (13.5%, 95% confidence interval [CI], 11.1-16.2). It was independently associated with aortic valve stenosis (odds ratio [OR], 5.4; 95% CI, 3.0-9.8; P <.001), age (OR, 1.05; 95% CI, 1.02-1.08; P <.001), female sex (OR, 3.5; 95% CI, 1.8-6.8; P <.001), contrast volume (OR, 1.006; 95% CI, 1.001-1.012; P = .019 per 10 mL of contrast volume), documented cardiomyopathy (OR, 2.5; 95% CI, 1.0-6.0; P = .045), and mitral regurgitation (OR, 2.3; CI, 1.0-4.9; P = .033). In contrast, operator experience and extent of coronary artery disease were not found to be associated with acute cardiomyocyte injury.

Conclusions

Cardiomyocyte injury accompanies elective coronary angiography in 1 of 8 patients. Sex, age, contrast agent volume, and ventricular disease, rather than the extent of coronary artery disease, independently predict cardiomyocyte injury. Further research aiming to reduce the incidence of cardiomyocyte injury seems warranted.

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.

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