Author + information
- Tomoya Ueda,
- Shiro Uemura,
- Yu Sugawara,
- Tsunenari Soeda,
- Makoto Watanabe,
- Yukiji Takeda,
- Hiroyuki Kawata and
- Yoshihiko Saito
Periprocedural cardiac enzyme elevation after percutaneous coronary intervention (PCI) occurs frequently and it is known as a predictor of adverse outcome. In this study, we studied the baseline morphological characteristics of culprit coronary plaques using optical coherence tomography (OCT), and evaluated their influence on troponin T elevation in patients undergoing elective PCI.
We enrolled 77 patients with stable angina pectoris who were treated with elective PCI (68.5 y/o, 75.3% men). Periprocerural cardiac enzyme elevation was defined as increment of serum troponin T (TnT) levels more than 4 times of baseline, and patients were divided into two groups as elevation group (TnT ⊠ 0.056, n=47) and non–elevation group (TnT < 0.056, n=30). OCT examination of culprit lesion was performed before and after PCI, and OCT–based tissue characteristics were evaluated within 10–mm length segment of each culprit lesion.
There was no difference in clinical background between two groups. Culprit lesion was distributed in left anterior descending (50.7%), right coronary artery (32.5%) and left circumflex (14.3%) arteries. Minimum limen diameter and minimum lumen area were similar between two groups. Although length (3.58 ± 3.13 vs. 2.61 ± 2.67 mm) and maximum angle (186.2 ± 122.3 vs. 158.3 ± 142.8 degree) of lipid accumulation did not differ between two groups, thin–cap fibroatheroma (TCFA) was more frequently observed in elevation group than non–elevation group (29.8 vs. 10.0%, p=0.03). Calcium deposition was more frequently observed in elevation group than non–elevation group (85.1 vs. 63.3%, p=0.03). TCFA with calcium deposition was an independent and the strongest predictor of elevation of TnT after elective PCI (OR: 23.4, 95% CI: 3.23–493.8, p<0.01).
OCT examination showed that TCFA with calcium deposition was a powerful predictor of cardiac enzyme elevation after elective PCI. Although mechanism should be further elucidated, concomitant existence of hard calcified tissue around lipid–rich culprit lesion might enhance the leakage of lipid component into coronary circulation during PCI.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Intravascular Imaging: IVUS and OCT
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2108–238
- 2013 American College of Cardiology Foundation