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Impact of atherosclerotic plaque composition on coronary microembolization during percutaneous coronary interventions

Dirk Böse1, Clemens von Birgelen, Xiu Ying Zhou

  • 1Dept. of Cardiology, West German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany. dirk.boese@uk-essen.de

Basic Research in Cardiology
|September 13, 2008
PubMed

Insights

Necrotic core (NC) in coronary plaques, identified by intravascular ultrasound (IVUS) with radiofrequency data (IVUS-RF), predicts cardiac marker release after percutaneous coronary intervention (PCI). Larger NC volumes correlate with increased myocardial injury, aiding risk stratification.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomarkers

Background:

  • Cardiac marker release post-percutaneous coronary intervention (PCI) indicates myocardial necrosis.
  • This necrosis often stems from periprocedural (micro)embolization of atherothrombotic debris.
  • Such events are linked to impaired left ventricular function and adverse outcomes.

Purpose of the Study:

  • To investigate the relationship between coronary plaque composition and microembolization after PCI.
  • To assess if intravascular ultrasound with radiofrequency data (IVUS-RF) can predict cardiac marker release.

Main Methods:

  • Prospective study of 55 patients undergoing direct stenting for single de-novo lesions.
  • Pre-PCI plaque composition analyzed using IVUS-RF (Virtual Histology).
  • Serial measurements of cardiac markers (creatine kinase and troponin I) before and up to 24 hours after PCI.

Main Results:

  • Plaque necrotic core (NC) volume significantly correlated with the maximum increase in cardiac markers (CK and CTnI).
  • Patients with larger NC volumes (>10.8 mm(3)) showed a particularly high increase in cardiac markers.
  • Total plaque volume and other plaque components (fibrous, fibro-fatty, calcium) did not correlate with cardiac marker release.

Conclusions:

  • Large necrotic cores in culprit lesions are associated with greater myocardial injury due to peri-interventional microembolization.
  • IVUS-RF assessment before PCI can identify high-risk lesions.
  • This identification may help tailor PCI strategies to minimize myocardial damage.
Abstract

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