Abstract 16544: Impact of Coronary Plaque Characteristics assessed by Optical Coherence Tomography on Cardiac Troponin Elevation After Percutaneous Coronary Intervention
Background: Recent studies have demonstrated an association between cardiac biomarker elevation after percutaneous coronary intervention (PCI) and increased adverse outcome. Optical coherence tomography (OCT) provides accurate coronary lesion characteristics. We sought to examine the association between cardiac troponin elevation after PCI and pre-PCI OCT findings.
Methods and Results: We studied 103 native de novo culprit coronary lesions in 93 patients with a baseline normal troponin I levels (86 stable angina pectoris, SAP and 17 unstable angina pectoris, UAP) who underwent pre-PCI OCT examination before elective stent implantation. The frequency of cardiac troponin I elevation more than 3 times URL after PCI was determined, and lesions were divided into two groups of non-Tn group and elevated-Tn group. Angiographic analysis was performed by quantitative coronary angiographic analysis (QCA). Quantitative and qualitative assessments by OCT were performed by two independent observers and the results were compared between the groups. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque (one or more quadrants) with fibrous cap thickness <70μm. Twenty-one lesions (20% SAP: 15, UAP: 6) showed troponin I elevation (elevated-Tn group) and 82 lesions (80% 71: SAP, 11: UAP) were classified as in non-Tn group. There was no significant difference in the clinical presentations between the two groups. In QCA analysis, there were no significant differences in % diameter stenosis, lesion length, and minimum lumen diameter. In OCT analysis, there were no significant differences in the presence of ruptured plaque (19% vs. 9%, p=0.23), number of lipid quadrants (2.0±1.6 vs. 1.9±1.4, p=0.76), and the thinnest cap thickness (86±50μm vs. 104±49μm, p=0.19) between the two groups. However TCFA was significantly more frequently observed in elevated-Tn group than in non-Tn group (43% vs. 16%, p=0.01).
Conclusions: The OCT analysis revealed that the presence of TCFA might predict post-PCI myocardial infarction in patients with baseline normal troponin levels. OCT may play an important role in detecting high risk lesions for PCI-related myocardial infarction.
- © 2010 by American Heart Association, Inc.