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Predictive Value of Aortic Valve Calcification for Periprocedural Myocardial Injury in Patients Undergoing
Yohei Shibata1, Hideki Ishii1, Susumu Suzuki1
1Department of Cardiology, Nagoya University Graduate School of Medicine.
Insights
Aortic valve calcification (AVC) presence predicts periprocedural myocardial injury (PMI) in patients undergoing percutaneous coronary intervention (PCI). This finding aids in identifying patients at higher risk for adverse outcomes after PCI.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Aortic valve calcification (AVC) is linked to cardiovascular events and mortality.
- Periprocedural myocardial injury (PMI) during percutaneous coronary intervention (PCI) predicts poor clinical outcomes and mortality.
Purpose of the Study:
- To evaluate if aortic valve calcification (AVC) can predict periprocedural myocardial injury (PMI) in patients undergoing PCI.
Main Methods:
- Ultrasound cardiography (UCG) identified AVC (bright echoes >1 mm on aortic valve cusps).
- PMI was defined by a >5-fold increase in high-sensitivity troponin T (>0.070 ng/ml) at 24 hours post-PCI.
- 370 patients with stable angina undergoing PCI were analyzed.
Main Results:
- AVC was present in 45.9% of patients.
- PMI incidence was significantly higher in patients with AVC (43.5%) compared to those without (21.0%, p<0.001).
- AVC independently predicted PMI (OR 2.26; 95% CI 1.37-3.74, p=0.002), improving prediction models (AUC 0.68 to 0.72, p=0.025).
Conclusions:
- Aortic valve calcification detected by UCG is a predictor of periprocedural myocardial injury in PCI patients.
Aims:
Previous studies have shown that aortic valve calcification (AVC) was associated with cardiovascular events and mortality. On the other hand, periprocedural myocardial injury (PMI) in percutaneous coronary intervention (PCI) is a well-known predictor of subsequent mortality and poor clinical outcomes. The purpose of the study was to assess the hypothesis that the presence of AVC could predict PMI in PCI.
Methods:
This study included 370 patients treated with PCI for stable angina pectoris. AVC was defined as bright echoes ＞1 mm on one or more cusps of the aortic valve on ultrasound cardiography (UCG). PMI was defined as an increase in high-sensitivity troponin T level of ＞5 times the upper normal limit (＞0.070 ng/ml) at 24 hours after PCI.
Results:
AVC was detected in 45.9% of the patients (n=170). The incidence of PMI was significantly higher in the patients with AVC than in those without AVC (43.5% vs 21.0%, p＜0.001). The presence of AVC independently predicted PMI after adjusting for other significant variables (odds ratio 2.26, 95% confidence interval 1.37-3.74, p=0.002). Other predictors were male sex, age, estimated glomerular filtration rate, and total stent length. Furthermore to predict PMI, adding AVC to the established risk factors significantly improved the area under the receiver operating characteristic curves, from 0.68 to 0.72, of the PMI prediction model (p=0.025).
Conclusion:
The presence of AVC detected in UCG could predict the incidence of PMI.
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