Related Experiment Video
Updated: Jun 21, 2026
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Impact of plaque composition on cardiac troponin elevation after percutaneous coronary intervention: an ultrasound
Young Joon Hong1, Gary S Mintz, Sang Wook Kim
1Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
Insights
Virtual histology-intravascular ultrasound (VH-IVUS) identified that a larger necrotic core area in coronary lesions predicts elevated cardiac troponin I (cTnI) after percutaneous coronary intervention (PCI). This imaging technique can help identify high-risk lesions for myocardial necrosis post-PCI.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) can lead to myocardial necrosis, indicated by elevated cardiac markers.
- Understanding predictors of post-PCI myocardial necrosis is crucial for patient outcomes.
Purpose of the Study:
- To investigate the association between pre-PCI coronary plaque characteristics, assessed by virtual histology-intravascular ultrasound (VH-IVUS), and post-PCI cardiac troponin I (cTnI) elevation.
- To identify specific plaque features that predict myocardial injury following PCI.
Main Methods:
- VH-IVUS imaging was performed on 80 patients before PCI.
- Patients were categorized based on post-PCI cTnI levels (elevated vs. normal).
- Coronary plaque characteristics, including necrotic core volume and area, were analyzed.
Main Results:
- Patients with elevated post-PCI cTnI had significantly larger absolute and percent necrotic core volumes and areas compared to those without elevation.
- Absolute necrotic core area at the minimum lumen site was a significant predictor of post-PCI cTnI elevation.
- Correlations were found between cTnI elevation and necrotic core area/volume, fibrofatty area, and plaque burden.
Conclusions:
- VH-IVUS reveals that lesions with a large necrotic core are associated with post-PCI cTnI elevation.
- VH-IVUS can identify coronary lesions at high risk for myocardial necrosis after PCI.
- This imaging modality may aid in risk stratification and procedural planning.
Objectives:
We used virtual histology-intravascular ultrasound (VH-IVUS) to study the relationship between pre-percutaneous coronary intervention (PCI) coronary plaque characteristics and post-PCI cardiac troponin I (cTnI) elevation.
Background:
Percutaneous coronary intervention is often complicated by post-procedural myocardial necrosis as manifested by elevated cardiac markers.
Methods:
Eighty consecutive patients (29 stable and 51 unstable angina) with normal pre-PCI cTnI levels were imaged before PCI using VH-IVUS. Patients were divided into 2 groups according to the presence (Group I, n = 38) or absence (Group II, n = 42) of post-PCI cTnI elevation > or =3x the upper limit of normal (0.08 ng/ml).
Results:
The absolute and percent necrotic core volumes were significantly greater in Group I than in Group II (13.6 +/- 6.4 mm(3) vs. 7.9 +/- 4.4 mm(3), p < 0.001, and 19.8 +/- 10.4% vs. 12.8 +/- 8.4%, p = 0.015, respectively). The absolute and percent necrotic core areas were significantly greater in Group I than in Group II at the minimum lumen site (1.70 +/- 0.91 mm(2) vs. 0.61 +/- 0.39 mm(2), p < 0.001, and 22.9 +/- 11.7% vs. 10.4 +/- 6.6%, p < 0.001, respectively) and at the largest necrotic core site (2.00 +/- 0.86 mm(2) vs. 0.81 +/- 0.78 mm(2), p < 0.001, and 24.0 +/- 11.7% vs. 12.9 +/- 6.6%, p < 0.001, respectively). The DeltacTnI correlated with: 1) absolute and percent necrotic core area at the minimum lumen site and at the largest necrotic core site; 2) absolute necrotic core volume; 3) percent fibrofatty area at the minimum lumen site; and 4) lesion site plaque burden. In the multivariate analysis, absolute necrotic core area at the minimum lumen site was the only independent predictor of post-PCI cTnI elevation > or =3x the upper limit of normal (odds ratio: 1.318; 95% confidence interval: 1.090 to 1.594, p = 0.004).
Conclusions:
The VH-IVUS analysis shows that post-PCI cTnI elevation occurs in lesions with a large necrotic core area. The VH-IVUS may play an important role in detecting which lesions are high risks for myocardial necrosis after PCI.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome I: Introduction
01:28Imaging Studies for Cardiovascular System V: CT
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations