Author + information
- Rikuta Hamaya,
- Taishi Yonetsu,
- Tadashi Murai,
- Yoshihisa Kanaji,
- Eisuke Usui,
- Masahiro Hoshino,
- Takayuki Niida,
- Masahiro Hada,
- Sadamitsu Ichijo,
- Yoshinori Kanno and
- Tsunekazu Kakuta
Background: Procedure-related myocardial necrosis (PMN) following diagnostic coronary angiography (CAG) including adjunctive catheter-based diagnostic procedures has not been well investigated. The aim of this study was to clarify the patients’ and procedural characteristics that associated with PMN using high-sensitivity cardiac troponin I (hs-cTnI) assay, and to investigate the implication of PMN in clinical outcomes.
Methods: A total of 538 patients (110 females), who were scheduled for elective CAG were prospectively enrolled. Pre- and post-procedural hs-cTnI levels were determined, and patients showing pre-procedural hs-cTnI more than 99% URL were excluded. Minor (post-procedural hs-cTnI> 99% URL) and major (post-procedural hs-cTnI > 5 times of 99 % URL) PMN were defined in the present study. Clinical and procedural factors to predict PMN, and impact of PMN on major adverse cardiac events (MACE) after CAG were investigated.
Results: Median pre- and post-procedural hs-cTnI values were 4 ng/L (IQR: 3-8 ng/L) and 16.5 ng/L (IQR: 7-39.3 ng/L, p<0.01), respectively. Of all, minor PMN was detected in 178 patients (33.0%), while major PMN was observed in 32 patients (5.9%). In multivariate analysis, female gender, eGFR, procedural time, left ventricular end-diastolic pressure (LVEDP) and fractional flow reserve examination were independently associated with minor PMN; on the other hand, only LVEDP was the independent predictor for major PMN (all; p<0.05). Incidence of MACE during two-year follow-up was significantly associated with the presence of major PMN, whereas no significant relationship was observed with minor PMN. Cox proportional hazards model revealed that major PMN, pre-procedural hs-cTnI and absence of statin use were independently associated with MACE.
Conclusions: Diagnostic catheterization-related minor hs-cTnI leak was associated with patient characteristics and procedural factors, while increased LVEDP was associated with major PMN. Impact of PMN on MACE was dependent of the magnitude of hs-cTnI rise. Assessment of post-CAG hs-cTnI elevation may help identify high-risk patients for worse clinical outcomes.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-345
- 2017 American College of Cardiology Foundation