Abstract 14391: Influence of Coronary Plaque Morphologies by Intravascular Ultrasound and Optical Coherence Tomography on the Occurrence of Periprocedural Myocardial Infarction in Patients With Stable Angina Pectoris
Background: Periprocedural myocardial infarction (PMI) is an important and not uncommon complication observed after percutaneous coronary intervention (PCI) in patients with coronary artery disease. Prediction of PMI before PCI is important. We sought to investigate the predictors of PMI in patients with stable angina pectoris (SAP) by using intravascular imaging modalities.
Methods: We investigated 128 consecutive SAP lesions which underwent pre-PCI intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The occurrence of PMI was defined by elevation of cardiac troponin T (cTnT) level at 24h after PCI ≥5 times the upper limit of normal range in patients with normal baseline values (cTnT <0.014ng/ml) or ≥5 times the baseline values if elevated ≥0.014ng/ml before PCI). All lesions were divided into lesions with PMI and those without. Clinical characteristics and plaque morphologies on IVUS and OCT were compared between the two groups. Univariate and multivariate logistic regression analysis for prediction of PMI was performed.
Results: PMI was observed in 56 (43.8%) lesions. Lesions with PMI had higher frequencies of OCT-derived thin-cap fibroatheroma (TCFA) (fibrous-cap thickness <70μm and lipid arc >180°) (30.4% vs. 6.9%, p<0.001), attenuated plaque on IVUS (35.7% vs. 16.7%, p<0.001), chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2) (55.4% vs. 37.5%, p=0.04), and lesion at right coronary artery (42.9% vs. 20.8%, p=0.007), and longer stent length (24.2±7.2 vs. 21.4±7.5mm, p=0.03) and larger plaque burden (82.5±5.5 % vs. 78.8±9.9%, p=0.009). Multivariate analysis revealed that OCT-TCFA (odds ratio (OR): 4.48, 95% CI: 1.40-14.32, p=0.01), attenuated plaque on IVUS (OR: 7.32, 95% CI: 2.36-22.69, p<0.001), stent length (OR: 1.06, 95% CI: 1.01-1.13, p=0.03), and CKD (OR: 2.78, 95% CI: 1.20-6.47, p=0.02) were significant predictors of PMI. For predicting PMI, combination of OCT-TCFA and attenuated plaque on IVUS showed 98.6% of specificity and 90.0% of positive predictive value.
Conclusion: Assessment of plaque morphologies by pre-PCI IVUS and OCT may be useful in the prediction of periprocedural myocardial infarction in SAP patients.
- © 2013 by American Heart Association, Inc.