Author + information
- Mori Atsushi1
Periprocedural myocardial infarction (PMI), which is defined as peak high-sensitivity cardiac Troponin T (hs-cTnT) during the 24 hours after PCI ≥0.07 ng/ml, is not an uncommon complication, and is associated with increased adverse cardiac event after PCI. The severity of coronary artery calcification (CAC) is well known as an independent predictor for coronary event and all-cause mortality. The object of this study is to clarify whether the severity of CAC is associated with incidence of PMI in patients with chronic coronary artery disease.
84 patients who underwent elective PCI from February 2014 to May 2015 were examined. Subjects with a history of PCI or CABG, acute coronary syndrome, hs-cTnT ≥0.07 ng/ml before PCI were excluded. We assessed cardiac biomarker by hs-cTnT and N-terminal Brain Natriuretic Peptide (NT-proBNP) on the day before and the following day of PCI. Multi-detector computed tomography was performed within 1 month before PCI. The CAC score was calculated using the standard Agatston criteria. We assessed major complication by death, myocardial infarction and bleeding. We compared the incidence of a cardiac event; cardiac death, heart failure admission, acute myocardial infarction, and revascularization.
Patients were divided into 2 groups according to hs-cTnT level after PCI: high TNT group (hs-cTnT≥0.7 ng/ml, n=38) and low TNT group (hs-cTnT<0.7 ng/ml, n=46). CAC score was higher in high TNT group (1467 ± 1374 vs 836 ± 943, p=0.0243). An increase of NT-proBNP level after PCI was larger in high TNT group (696 ± 1173 vs 1321 ± 1889, p<0.05). PMI was associated with CAC score >400 (ORs, 2.939, 1.067-8.095, p=0.037) and eGFR (ORs, 0.963, 0.929-0.998, p=0.039) in multivariable analysis. Many more cardiac events occurred in high CAC score >400 group and high TNT group. During the follow-up period, PCI for new lesion was performed more frequently in high TNT group (0% vs 24%, p=0.000). The rate of any revascularization was also higher (9% vs 29%, p=0.016).
High CAC score before PCI was associated with PMI after PCI. Measuring CAC score before PCI may help in predicting a future coronary event in these patients.