Abstract 12249: Coronary Plaque Evaluation by Computed Tomography and Post-Procedural Cardiac Troponin Elevation in Elective Stent Implantation
Background: Percutaneous coronary intervention (PCI) is often complicated by post-procedural myocardial necrosis as manifested by elevated cardiac biomarkers. We used multidetector computed tomography (MDCT) to study the relationship between culprit plaque characteristics and post-percutaneous coronary intervention cardiac troponin T (cTnT) elevation.
Methods: One hundred seven stable angina patients with normal pre-PCI cTnT levels underwent 64-slice MDCT before PCI. The plaque characteristics, CT attenuation value and remodeling index (RI) of culprit lesions were analyzed on MDCT. Patients were divided into 2 groups according to the presence (Group I, n=36) or absence (Group II, n=71) of post-PCI cTnT elevation ≥3×the upper limit of normal (0.010ng/ml) at 24 hours after PCI.
Results: CT attenuation value of the culprit plaque was significantly lower in Group I than in Group II (55.2±37.1 vs 88.3±38.7, P<0.001). The remodeling index was significantly greater in Group I than in Group II (1.20±0.18 vs 1.04±0.15, P<0.001). Plaques with spotty calcification were significantly more observed in Group I than in Group II (47% vs 11%, P<0.001). In the multivariate analysis, presence of positive remodeling (RI >1.10) and spotty calcification (OR 3.48; 95% CI, 1.19-10.5, P=0.013, OR 5.10; 95% CI, 1.73-16.1, P=0.003) were significantly independent predictors for cTnT elevation. Furthermore, CT attenuation value, RI and spotty calcification provided incremental predictive value of cTnT elevation above only CT attenuation value (C statics: CT attenuation value 0.741, CT attenuation value + RI + spotty calcification 0.788, P=0.007).
Conclusions: MDCT may play an important role in detecting which lesions are high risks for myocardial necrosis after PCI.
- © 2011 by American Heart Association, Inc.