LEANDRO MENEZES ALVES DA COSTA
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- Significant elevation of biomarkers of myocardial necrosis after coronary artery bypass grafting without myocardial infarction established assessed by cardiac magnetic resonance(2017) COSTA, Leandro Menezes Alves da; HUEB, Whady; NOMURA, Cesar Higa; HUEB, Alexandre Ciappina; VILLA, Alexandre Volney; OIKAWA, Fernando Teiichi Costa; MELO, Rodrigo Morel Vieira de; REZENDE, Paulo Cury; SEGRE, Carlos Alexandre Wainrober; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoThe release of myocardial necrosis biomarkers after off-pump coronary artery bypass grafting (OPCAB) frequently occurs. However, the correlation between biomarker release and the diagnosis of procedure-related myocardial infarction (MI) (type 5) has been controversial. This study aimed to evaluate the amount and pattern of cardiac biomarker release after elective OPCAB in patients without evidence of a new MI on cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). Patients with normal baseline cardiac biomarkers referred for elective OPCAB were prospectively included. CMR with LGE was performed in all patients before and after interventions. Measurements of troponin I (cTnI) and creatine kinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with new LGE on the postprocedure CMR were excluded. All of the 53 patients without CMR evidence of a procedure-related MI after OPCAB exhibited a cTnI elevation peak above the 99th percentile. In 48 (91%), the peak value was > 10 times this threshold. However, 41 (77%) had a CK-MB peak above the limit of the 99th percentile, and this peak was > 10 times the 99th percentile in only 7 patients (13%). The median peak release of cTnI was 0.290 (0.8-3.7) ng/mL, which is 50-fold higher than the 99th percentile. In contrast with CK-MB, considerable cTnI release often occurs after an elective OPCAB procedure, despite the absence of new LGE on CMR.
- Biomarker release after percutaneous coronary intervention in patients without established myocardial infarction as assessed by cardiac magnetic resonance with late gadolinium enhancement(2017) MELO, Rodrigo Morel Vieira de; HUEB, Whady; NOMURA, Cesar Higa; SILVA, Expedito Eustaquio Ribeiro da; VILLA, Alexandre Volney; OIKAWA, Fernando Teiichi Costa; COSTA, Leandro Menezes Alves da; REZENDE, Paulo Cury; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; RAMIRES, Jose Antonio Franchini; KALIL FILHO, RobertoObjectivesThis study aimed to evaluate the amount and pattern of cardiac biomarker release after elective percutaneous coronary intervention (PCI) in patients without evidence of a new myocardial infarction (MI) after the procedure as assessed by cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE). BackgroundThe release of myocardial necrosis biomarkers after PCI frequently occurs. However, the correlation between biomarker release and the diagnosis of procedure-related MI type 4a has been controversial. MethodsPatients with normal baseline cardiac biomarkers who were referred for elective PCI were prospectively included. CMR with LGE was performed in all of the patients before and after the intervention. Measurements of troponin I (TnI) and creatine kinase MB fraction (CK-MB) were systematically performed before and after the procedure. Patients with a new LGE on the post-procedure CMR were excluded. ResultsOf the 56 patients with no evidence of a procedure-related MI as assessed by CMR after the PCI, 48 (85.1%) exhibited an elevation of TnI above the 99th percentile. In 32 patients (57.1%), the peak was greater than five times this limit. Additionally, 17 patients (30.4%) had a CK-MB peak above the 99th percentile limit, but this peak was greater than five times the 99th percentile in only two patients (3.6%). The median peak release of TnI was 0.290 (0.061-1.09) ng/mL, which was 7.25-fold higher than the 99th percentile. ConclusionsIn contrast to CK-MB, an abnormal release of TnI often occurs after an elective PCI procedure, despite the absence of a new LGE on CMR.
conferenceObject Quality of life and economic outcomes of on-pump and off-pump stable multivessel coronary artery bypass grafting - MASS III trial 5-year follow-up(2017) SCUDELER, T. L.; HUEB, W.; SOAREZ, P. C. De; CAMPOLINA, A. G.; REZENDE, P. C.; LIMA, E. G.; GARZILLO, C. L.; AZEVEDO, D. F. C.; COSTA, L. M. A.; OIKAWA, F. T. C.; RAMIRES, J. A. F.; KALIL FILHO, R.conferenceObject COST-EFFECTIVENESS ANALYSIS AND QUALITY OF LIFE OF ON-PUMP AND OFF-PUMP STABLE MULTIVESSEL CORONARY ARTERY BYPASS GRAFTING: MASS III TRIAL 5-YEAR FOLLOW-UP(2017) SCUDELER, Thiago; HUEB, Whady; SOAREZ, Patricia Coelho De; CAMPOLINA, Alessandro G.; REZENDE, Paulo; LIMA, Eduardo; GARZILLO, Cibele Larrosa; FREITAS, Diogo Freitas Cardoso; COSTA, Leandro; OIKAWA, Fernando Teiichi; RAMIRES, Jose; KALIL FILHO, Roberto- Abnormal elevation of myocardial necrosis biomarkers after coronary artery bypass grafting without established myocardial infarction assessed by cardiac magnetic resonance(2017) OIKAWA, Fernando Teiichi Costa; HUEB, Whady; NOMURA, Cesar Higa; HUEB, Alexandre Ciappina; VILLA, Alexandre Volney; COSTA, Leandro Menezes Alves da; MELO, Rodrigo Morel Vieira de; REZENDE, Paulo Cury; SEGRE, Carlos Alexandre Wainrober; GARZILLO, Cibele Larrosa; LIMA, Eduardo Gomes; RAMIRES, Jose Antonio Franchini; FILHO, Roberto KalilBackground: The diagnosis of peri-procedural myocardial infarction is complex, especially after the emergence of high-sensitivity markers of myocardial necrosis. Methods: In this study, patients with normal baseline cardiac biomarkers and formal indication for elective on-pump coronary bypass surgery were evaluated. Electrocardiograms, cardiac biomarkers, and cardiac magnetic resonance imaging with late gadolinium enhancement were performed before and after procedures. Myocardial infarction was defined as more than ten times the upper reference limit of the 99th percentile for troponin I and for creatine kinase isoform (CK-MB) and by the findings of new late gadolinium enhancement on cardiac magnetic resonance. We assessed the release of cardiac biomarkers in patients with no evidence of myocardial infarction on cardiac magnetic resonance. Results: Of 75 patients referred for on-pump coronary bypass surgery, 54 (100%) did not have evidence of myocardial infarction on cardiac magnetic resonance. However, all had a peak troponin I above the 99th percentile; 52 (96%) had an elevation 10 times higher than the 99th percentile. Regarding CK-MB, 54 (100%) patients had a peak CK-MB above the 99th percentile limit, and only 13 (24%) had an elevation greater than 10 times the 99th percentile. The median value of troponin I peak was 3.15 (1.2 to 3.9) ng/mL, which represented 78.7 times the 99th percentile. Conclusion: In this study, different from CK-MB findings, troponin was significantly increased in the absence of myocardial infarction on cardiac magnetic resonance. Thus, CK-MB was more accurate than troponin I for excluding procedure-related myocardial infarction. These data suggest a higher troponin cutoff for the diagnosis of coronary bypass surgery related myocardial infarction.