Abstract 9915: A Less-Invasive and Quantitative Prediction for Periprocedural Myocardial Injuries During Elective Percutaneous Coronary Intervention by Detection of High-intensity Plaques on Non-contrast T1-weighted Magnetic Resonance Imaging
Background: Periprocedural myocardial injuries (pMI) are associated with immediate and long-term adverse outcomes due to distal embolization. Coronary high-intensity plaques (HIPs) detected on non-contrast T1-weighted imaging (T1WI) are associated with characteristics of vulnerable plaques, including positive remodeling, lower Hounsfield units on computed tomography, and ultrasound attenuation. We hypothesized that coronary HIPs may predict pMI during elective percutaneous coronary intervention (PCI).
Methods: Fifty-seven consecutive patients with coronary artery disease underwent cardiac magnetic resonance (CMR) within 3 months prior to PCI to calculate the plaque-to-myocardium signal intensity ratio (PMR: Figure A). pMI was defined as cardiac troponin T elevation of more than 5 times the 99th percentile of the upper reference limit.
Results: CMR studies were performed a median of 2 days (interquartile range (IQR), 1-24) before the PCI. Following PCI, 6 patients (11%) and 15 patients (27%), respectively, developed the slow flow phenomenon and pMI. Median (IQR) PMR at the PCI lesion was higher in patients with pMI than those without it (1.3 [1.1-2.0] vs. 1.0 [0.8-1.2], p = 0.014). Receiver operating characteristic analysis revealed that a PMR ≥1.3 was the optimal cutoff value to predict pMI (sensitivity 67% and specificity 86%; AUC = 0.71). Multivariate analysis showed that a PMR ≥1.3 was a significant predictor of pMI (odds ratio, 6.96; 95% confidence interval, 1.15-53.7; p = 0.035: Figure B).
Conclusions: HIPs on non-contrast T1WI identified in a less invasive, quantitative manner may identify coronary plaques at high risk of myocardial injuries following PCI.
Author Disclosures: Y. Asaumi: None. T. Noguchi: None. Y. Morita: None. R. Fijiwara: None. T. Kanaya: None. T. Matsuyama: None. T. Kawasaki: None. M. Fujino: None. T. Nagai: None. T. Yamane: None. T. Miyagi: None. H. Ishibashi-Ueda: None. M. Higashi: None. M. Ishihara: None. H. Ogawa: None. S. Yasuda: None.
- © 2014 by American Heart Association, Inc.