Abstract 1971: Prediction of Post-procedural Myocardial Infarction or Myocardial injury After Elective Stent Implantation by Volumetric Tissue Characterization Using Integrated Backscatter Intravascular Ultrasound
Background: Procedure-related myocardial infarction or myocardial injury (PMI) is a frequent complication of percutaneous coronary intervention. However association between tissue characterization of coronary lesion and PMI was unknown.
Methods: 86 consecutive patients who performed elective stent implantation after integrated backscatter intravascular ultrasound (IB-IVUS) analysis were enrolled.Color coded maps of tissue characteristics of each 1mm slice in target lesions were constructed and volume of each plaque components (calcification −11~−29dB IB-value, fibrous −29~−49dB IB-value,and lipid core ≤ 49 dB IB-value) was calculated using Simpson’s method. Post-procedural myocardial injury was evaluated by analysis of creatin phosphokinase (CPK), creatin kinase MB isoform (CK-MB) and troponin-T (TnT) 18 hours after PCI. PMI was defined as post-procedural TnT elevation higher than 3 times of normal range.Multiple logistic regression analysis was used to estimate the association of PMI with volume of plaque components, clinical and lesion characteristics.
Results: Total plaque volume of target lesion and volume of each component significantly correlated with post procedural TnT, CPK and CK-MB. Volume of lipid core and calcification are significantly higher in patient with PMI ( 84.9 ± 67.0mm3 vs 48.3 ± 42.7 mm3 p < 0.01, 22.8 ± 13.1 mm3 vs 15.6 ± 11.2 mm3 p < 0.05 respectively). Multiple logistic regression analysis revealed volume of lipid core is independent predictor of PMI ( p = 0.028, OR 1.037/mm3, CI 1.004–1.071/mm3 ). Receiver operating characteristic analysis identified a volume of lipid core of 41.9 mm3 as the best discriminating value, with a sensitivity of 78.6% and specificity of 61.1% for detection of PMI ( AUC = 0.69 p = 0.02 )
Conclusions: Volume of lipid core is larger in patient with PMI and independent predictor of PMI. Larger plaque volume and vulnerable plaque characteristics may be potent source of thrombogenic event after stent implantation, resulting in PMI. Volumetric plaque characterization using IB-IVUS is useful method to predict occurence of PMI after elective stenting.