Increase in serum troponin-I following rotational atherectomy reliably predicts the occurrence of reversible wall motion abnormalities.
BACKGROUND: There is growing evidence that microdebris pulverized by rotational atherectomy (RA) may have a deleterious effect on coronary microcirculation and ventricular contraction. However, the incidence and the predictors of worsening of left ventricular wall motion following RA are unknown. METHODS: Thirty patients without a known previous anterior wall myocardial infarction who underwent RA-facilitated angioplasty for de novo lesions of left anterior descending coronary artery were evaluated. Global and anterior wall regional left ventricular ejection fraction (LVEF and AREF) were analyzed before and after RA. Serum troponin-I, CK, and CK-MB concentrations were assayed. RESULTS: Target lesion length was greater (P=0.03), post-procedural minimal lumen diameter was smaller (P<0.01), and serum troponin-I immediately after RA was higher (P=0.01) in 16 patients with a decrease in the AREF of at least 15% than in those without. Stepwise logistic regression analysis identified one independent predictor of such worsening of AREF, troponin-I> or =0.1 ng/ml immediately after the procedure (P<0.01), with sensitivity of 81%, specificity of 79%, and relative risk of 3.8. CONCLUSIONS: Our results suggest that RA can cause substantial deterioration in left ventricular wall motion. Serum troponin-I, a sensitive indicator of myocardial damage, may be useful in predicting reversible LV wall motion abnormalities following RA.