Abstract 11586: Microembolization and Myonecrosis During Elective Percutaneous Coronary Interventions in Diabetic Patients: An Intracoronary Doppler Ultrasound Study
Background: Elevation of cardiac troponin I (cTnI) is a well-known complication after percutaneous coronary interventions (PCI). It remains controversial if angiographic and anatomical factors are independent predictors for PCI-related myonecrosis.
Objectives: Aim of this study was to (1) quantify the extent of coronary microembolization during elective PCI and to (2) identify predictors for periprocedural myonecrosis in a high risk patient population.
Methods: 48 consecutive patients (38 males, 66.7 ± 6.1 years) with type 2 diabetes and multivessel coronary artery disease underwent elective PCI with stent placement to treat a single-vessel lesions. Real-time microembolization was detected as high intensity transient signals (HITS) by an intracoronary Doppler guide wire (Flowire, Volcano) during PCI. Peak levels of cTnI were measured within 24 hours after PCI
Results: Microemboli were detected during PCI in all but one patient. Based on our proposed lesion and interventional complexity score most lesions (n = 40) were graded as complex (n = 29; 60.4 %) or very complex (n = 11; 22.9 %). Pathological, but subclinical, postprocedural elevation of cTnI > 0.12 ug/l (0.13 to 28.9, median 0.39 ug/ml) occured in 19 patients. The total count of microemboli (HITS) correlated with the peak value of cTNI (r = 0.43, p = 0.003). Side branch occlusion with subsequent dilation with or without flow restoration was significantly associated with microinfarction (p < 0.001, figure 1b). We found no other correlations with clinical, angiographic or procedural data. ROC analysis demonstrated that a high number of HITS (> 25) predicted a major cTnI elevation > 1 ng/ml with a sensitivity of 100% and specificity of 83 % (p = 0.002, figure 1a).
Conclusion: In this relatively small study only the extent of coronary microembolization predicted the occurrence of periprocedural myonecrosis during elective PCI. Anatomical and interventional complexity of the lesion was not predictive.
- © 2011 by American Heart Association, Inc.