Abstract 18909: Impact of Coronary Plaque Morphology Assessed by Optical Coherence Tomography on Periprocedural Cardiac Troponin Elevation in Patients With Non-ST Segment Elevation Acute Coronary Syndrome
Backgrounds and Aims: We used optical coherence tomography (OCT) to study the relationship between pre-PCI plaque morphology and PCI-related cTn elevations in patients with non-ST-segment elevation acute coronary syndrome (NATE-ACS). We further assessed the association between PCI-related cTn elevations and adverse cardiac event during follow-up in these patients.
Methods and Results: We studied 165 patients with NSTE-ACS who had identifiable native de novo culprit lesions suitable for PCI and OCT examination. All patients underwent OCT imaging before stent implantation. Cardiac troponin I (cTnI) was analyzed on admission, before PCI, and after PCI, and periprocedural myocardial injury (PMI) was defined as a patient showing stable pre-PCI cTnI values or fall, followed by post-PCI cTnI rise >20%. Forty patients (24.2%) with increasing cTnI values before PCI were excluded from subsequent analyses. We finally evaluated 126 patients with stable or falling cTnI values after admission. Clinical and OCT findings were compared between patients with (n=58, 46%) or without (n=68, 54%) PMI. After PCI, long-term follow-up data were collected. Thin-cap fibroatheroma (TCFA) was defined as lipid-rich plaque (one or more quadrants) with fibrous cap thickness < 70μm. PMI was associated with prior PCI (PMI: 29.3 %, non-PMI: 5.9 %, P = 0.001), angiographic lesion length (PMI: median 15.3 mm [IQR: 12.2-17.8], non-PMI: 12.6 mm [IQR: 10.9-16.9], P=0.040), presence of OCT-derived TCFA (PMI: 65.5 %, non-PMI: 35.3 %, P = 0.001), and plaque rupture (PMI: 43.1 %, non-PMI: 25.0 %, P=0.032). In multivariable analysis, presence of TCFA (OR, 3.51; 95% CI, 1.59 to 7.72, P = 0.002) and prior PCI (OR, 7.62; 95% CI, 2.22 to 26.10, P = 0.001) were independent predictors of PMI. At a median follow-up of 33.5 months, event free survival (ACS, stroke, cardiac death) was significantly worse in patients with PMI (log-rank test χ2 = 6.83, P = 0.009).
Conclusions: OCT analysis showed that PCI-related myocardial injury occurs more frequently in lesions with TCFA in NSTE-ACS patients. OCT may allow identification of NSTE-ACS patients who are likely to have PCI-related myocardial injury, who may have higher risk of adverse cardiac events during follow-up despite otherwise successful PCI.
Author Disclosures: T. Lee: None. T. Murai: None. A. Suzuki: None. Y. Kanaji: None. J. Matsuda: None. M. Araki: None. T. Niida: None. M. Isobe: None. T. Kakuta: None.
- © 2014 by American Heart Association, Inc.