Abstract 1913: Prediction of Post-procedural Myocardial Infarction or Myocardial Injury After Elective Stent Implantation by Volumetric Tissue Characterization Using 64-slice Multi Detector Computed Tomography
Background: Procedure-related myocardial infarction or myocardial injury (PMI) is a frequent complication of percutaneous coronary intervention (PCI). However association between tissue characterization of coronary lesion and incidence of post-procedural PMI was unknown.
Methods: 79 consecutive patients who performed elective stent implantation after coronary CT analysis using Multi-Detector Computed Tomography (MDCT, Light Speed VCT, GE Medical Systems ) were enrolled. Each plaque components and lumen (filled with dye) were defined as follows ;
Volume of each plaque component in target lesion was calculated. PMI was evaluated by analysis of creatin phosphokinase (CPK), creatin kinase MB isoform (CK-MB) and troponin-T (TnT) 18 hours after PCI. Multiple logistic regression analysis was used to estimate the association of PMI (defined as TnT > normal X3) with volume of plaque components, clinical and lesion characteristics.
Results: Volume of soft plaque correlated with post-procedural TnT ( r = 0.58, p < 0.0001) and CPK( r = 0.54, p < 0.0001) and CK-MB ( r = 0.50,p < 0.0001). Fraction of soft plaque (Soft plaque volume /total plaque volume) also correlated with post-procedural TnT ( r = 0.25, p < 0.05), CPK( r = 0.24, p < 0.05) and CK-MB ( r = 0.23, p < 0.05).Both soft plaque and fibrous plaque volume are higher in patients with PMI. Fraction of soft plaque is significantly higher and fraction of fibrous plaque is significantly lower in patient with PMI. Soft plaque volume was independent predictor of PMI (p < 0.01 OR 1.034/mm3 CI 1.011–1.059/mm3). Receiver operating characteristic analysis identified a volume of soft plaque of 218.3 mm3 as the best discriminating value, with a sensitivity of 69.2% and specificity of 95.5% for detection of PMI ( AUC= 0.87 p < 0.0001 )
Conclusions: Higher post-procedural TnT, CPK and CK-MB are associated with volume and fraction of soft plaque detected by MDCT. Soft plaque volume was independent predictor of PMI. Lager plaque volume and vulnerable plaque characteristics may be potent source of thrombogenic events after stent implantation, resulting in PMI. Plaque analysis using MDCT is useful method to predict occurence of PMI after elective stenting.