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Published on: August 28, 2018
Impact of coronary plaque composition on cardiac troponin elevation after percutaneous coronary intervention in
Hiroaki Watabe1, Akira Sato, Daiki Akiyama
1Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Insights
Multidetector computed tomography (MDCT) can identify culprit plaque characteristics, like positive remodeling and spotty calcification, that predict cardiac troponin T elevation after percutaneous coronary intervention (PCI). This helps identify lesions at high risk for myocardial necrosis post-PCI.
Area of Science:
- Cardiology
- Radiology
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) can lead to myocardial necrosis, indicated by elevated cardiac biomarkers.
- Understanding predictors of this complication is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between culprit plaque characteristics identified by multidetector computed tomography (MDCT) and cardiac troponin T (cTnT) elevation following PCI.
- To determine if MDCT can predict the risk of post-PCI myocardial necrosis.
Main Methods:
- 107 stable angina patients with normal pre-PCI cTnT underwent 64-slice MDCT before PCI.
- Patients were categorized based on post-PCI cTnT elevation (Group I) or absence thereof (Group II).
- Plaque characteristics evaluated included CT attenuation values, remodeling index, and calcification patterns.
Main Results:
- Group I (cTnT elevation) showed significantly lower CT attenuation values (43.0 HU) and higher remodeling indices (1.20) compared to Group II (94.0 HU, 1.04).
- Spotty calcification was more frequent in Group I (50%) than Group II (11%).
- Positive remodeling and spotty calcification were independent predictors of cTnT elevation (OR 4.54 and 4.27, respectively). A combination of three CT variables achieved 94% positive and 90% negative predictive value.
Conclusions:
- MDCT assessment of culprit lesions can identify patients at higher risk of myocardial necrosis after PCI.
- Plaque characteristics such as low CT attenuation, positive remodeling, and spotty calcification are associated with post-PCI cTnT elevation.
- MDCT imaging may aid in risk stratification for PCI procedures.
Objectives:
The authors used multidetector computed tomography (MDCT) to study the relation between culprit plaque characteristics and cardiac troponin T (cTnT) elevation after percutaneous coronary intervention (PCI).
Background:
Percutaneous coronary intervention is often complicated by post-procedural myocardial necrosis manifested by elevated cardiac biomarkers.
Methods:
Stable angina patients (n = 107) with normal pre-PCI cTnT levels underwent 64-slice MDCT before PCI to evaluate plaque characteristics of culprit lesions. Patients were divided into 2 groups according to presence (group I, n = 36) or absence (group II, n = 71) of post-PCI cTnT elevation ≥3 times the upper limit of normal (0.010 ng/ml) at 24 h after PCI.
Results:
Computed tomography attenuation values were significantly lower in group I than in group II (43.0 [26.5 to 75.7] HU vs. 94.0 [65.0 to 109.0] HU, p < 0.001). Remodeling index was significantly greater in group I than in group II (1.20 ± 0.18 vs. 1.04 ± 0.15, p < 0.001). Spotty calcification was observed significantly more frequently in group I than in group II (50% vs. 11%, p < 0.001). Multivariate analysis showed presence of positive remodeling (remodeling index >1.05; odds ratio: 4.54; 95% confidence interval: 1.36 to 15.9; p = 0.014) and spotty calcification (odds ratio: 4.27; 95% confidence interval: 1.30 to 14.8; p = 0.016) were statistically significant independent predictors for cTnT elevation. For prediction of cTnT elevation, the presence of all 3 variables (CT attenuation value <55 HU; remodeling index >1.05, and spotty calcification) showed a high positive predictive value of 94%, and their absence showed a high negative predictive value of 90%.
Conclusions:
MDCT may be useful in detecting which lesions are at high risk for myocardial necrosis after PCI.
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