Author + information
- Tetsumin Lee,
- Tadashi Murai,
- Toshiyuki Iwai,
- Takamitsu Takagi,
- Ryo Masuda,
- Yoshito Iesaka and
- Tsunekazu Kakuta
Recent studies have reported the development of neoatherosclerosis (NA) inside the stents in bare–metal stents (BMS) and drug–eluting stents (DES). We sought to examine the relationship between cardiac troponin elevation after PCI and pre–PCI optical coherence tomography (OCT) findings of in–stent restenosis (ISR) lesion.
We studied 80 ISR lesions in stable angina pectoris (SAP: n=76) and unstable angina pectoris (UAP: n=4) patients with a baseline normal cardiac troponin I (cTnI) level. The presence of pre–PCI OCT–defined lipid–laden neointima or calcification inside the stents was defined as NA. All lesions were divided into two groups (NA [n=33: 41%] and non–NA group [n=47: 59%]), and patient characteristics, stent type (BMS: 44, 55%, DES: 36, 45%), time since stent implantation (TIME; months), and post–procedural cTnI values were compared. Angiographic analysis was performed by quantitative coronary angiographic analysis (QCA).
There were no significant differences in the clinical presentations and QCA findings between the two groups. In NA group, TIME is significantly longer (NA: 57.1 [IQR: 16.0–113.4], non–NA: 9.9 [IQR: 8.0–11.8], P<0.01) and cTnI values were greater (NA: 0.19ng/mL [IQR: 0.05–0.39], non–NA: 0.03ng/mL [IQR: 0.00–0.18], P<0.01) than in non–NA group. In DES lesions, NA lesions showed significantly greater cTnI elevation than in non–NA (NA in DES: 0.19ng/mL [IQR: 0.05–0.39] vs non–NA in DES: 0.00ng/mL [IQR: 0.00–0.09], P<0.01), whereas NA in BMS showed a non–significant greater cTnI elevations than in non–NA ISR (NA in BMS: 0.20ng/mL [IQR]: 0.09–0.37] vs non–NA in BMS: 0.10ng/mL [IQR: 0.00–0.23], P=0.09). Peri–procedural myocardial damage (PMD) defined as elevated cTnI levels more than 0.30ng/mL after PCI was observed in 16 patients (20%), and significantly more frequently in patients with NA than in those without NA (NA: 33%, non–NA: 11%, P=0.02). In multivariable analysis, NA (OR: 4.04; 95% CI: 1.20–13.60; P=0.02) and eGFR (OR: 0.96; 95% CI: 0.93–0.99; P=0.04) were independent predictors of PMD.
NA is associated with cTnI elevation after elective PCI, especially in DES ISR lesions.
West, Room 2004
Monday, March 11, 2013, 8:00 a.m.–8:10 a.m.
Session Title: Intravascular Imaging: Focus on OCT
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2912–1
- 2013 American College of Cardiology Foundation