Abstract 14223: Impact of Coronary Plaque Composition on Cardiac Troponin Elevation After Percutaneous Coronary Intervention: A Computed Tomography Analysis
Background: Percutaneous coronary intervention (PCI) is often complicated by post-procedural myocardial necrosis as manifested by elevated cardiac biomarkers. We used multislice computed tomography (MSCT) to study the relationship between culprit plaque characteristics and post-PCI cardiac troponin T (TnT) elevation.
Methods: The study population consisted of 72 patients with normal pre-PCI TnT levels who were diagnosed as having coronary artery disease by 64-slice MSCT before PCI. The plaque characteristics, CT density value and remodeling index of culprit lesions were analyzed on MSCT. Positive remodeling (PR) was defined when the diameter at plaque site was at least 10% larger than the reference segment. Patients were divided into 2 groups according to the presence (Group I, n=24) or absence (Group II, n=48) of post-PCI TnT elevation >3×the upper limit of normal (0.010ng/ml) at 24 hours after PCI.
Results: Non-calcified plaques (NCP) with spotty calcification were significantly more observed in Group I than in Group II (55% vs 13%, P<0.001). The CT value of the culprit plaque was significantly lower in Group I than in Group II (48.1±32.4 vs 92.3±38.2, P<0.001). The remodeling index was significantly greater in Group I than in Group II (1.21±0.18 vs 1.00±0.12, P<0.001). Presence of PR, NCP < 50HU and spotty calcification showed a high positive predictive value, and absence of all 3 showed a high negative predictive value for the culprit plaque associated with post PCI cardiac TnT elevation (Table).
Conclusion: The MSCT may play an important role in detecting which lesions are high risks for myocardial necrosis after PCI.
- © 2010 by American Heart Association, Inc.