Abstract 18805: Prediction of Pre-procedural TIMI Flow Grade and Post-procedural Cardiac Troponin Elevations by 320-raw Multidetector Computed Tomography Myocardial Perfusion Imaging
Backgrounds: Computed tomography perfusion imaging (CTPI) is feasible, and the findings may be used as a diagnostic tool for predicting coronary TIMI flow grade or cardiac marker elevation after percutaneous coronary intervention (PCI) in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). We sought to investigate if detection of qualitative CTPI abnormality combined with CT coronary angiography (CTCA) findings can stratify the risk of NSTE-ACS patients before PCI.
Methods: The coronary CTCA and CTPI datasets of 130 NSTE-ACS patients (NSTEMI: 85, UA: 45) using 320-raw CT before percutaneous coronary intervention (PCI) were visually evaluated for the presence of coronary artery stenosis and perfusion defects. All patients underwent PCI within 48 hours from admission and CT examination. We excluded patients with cardiogenic shock, severe congestive heart failure, renal insufficiency. We also excluded patients without identifiable culprit lesions and/or suitable lesions for PCI. Perfusion defect (PD) was classified as none, inconclusive, or definite, and when inconclusive or definite PD judge was done, the PD location was assigned to RCA, LAD or LCX as culprit vessel based on a 16-segment American Heart Association model except for apex.
Results: Peak cardiac troponin I levels after PCI was 4.33 [0.84-10.5] ng/mL in total. Perfusion assessment was normal in 37, inconclusive in 53, and definite in 40 patients. In normal CTPI patients, initial TIMI flow grade 0 or 1 was detected in 3 patients out of 37 (8.1%), 6 out of 53 (11.1%) in inconclusive CTPI group, and 13 (32.5%) out of 40 in definite PD group (P=0.016). TIMI flow grade at the PCI completion ≦2 was detected in 1 patient out of 37 (3.0%) in normal group, 3 out of 53 (5.7%) in inconclusive group, and 5 (12.5%) out of 40 in definite group (P=0.042). Peak cardiac troponin I levels after PCI was 4.02 [1.02-9.83] ng/mL in normal group, 6.87 [1.02-23.4] ng/mL in inconclusive group, and 10.1 [3.25-24.2] ng/mL in definite group (P=0.016).
Conclusion: Myocardial perfusion detected by CTPI before PCI was associated with TIMI flow grade, and peak troponin I levels after PCI. CTPI, when added to CTCA, may help identify patients who may benefit from early coronary intervention and have high risk for PCI.
Author Disclosures: M. Araki: None. T. Niida: None. J. Matsuda: None. A. Suzuki: None. T. Murai: None. T. Lee: None. Y. Iesaka: None. T. Kakuta: None.
- © 2014 by American Heart Association, Inc.