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In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
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Efficacy of Multidetector Computed Tomography to Predict Periprocedural Myocardial Injury After Percutaneous Coronary

Eisuke Usui1, Tetsumin Lee, Tadashi Murai

  • 1Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital.

International Heart Journal
|January 20, 2017
PubMed

Insights

Multidetector computed tomography (MDCT) can predict periprocedural myocardial injury (PMI) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Lesion length and the napkin-ring sign on MDCT are key predictors of PMI, aiding risk stratification.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Radiology

Background:

  • Periprocedural myocardial injury (PMI) after percutaneous coronary intervention (PCI) is linked to worse patient outcomes.
  • Multidetector computed tomography (MDCT) can identify lesion characteristics that predict PMI in stable angina.
  • The role of preprocedural MDCT in predicting PMI after chronic total occlusion (CTO) PCI is not well-established.

Purpose of the Study:

  • To investigate the association between preprocedural culprit lesion characteristics visualized by MDCT and PMI following CTO PCI.
  • To identify MDCT-derived predictors of PMI in patients undergoing elective CTO PCI.

Main Methods:

  • Eighty-one patients undergoing pre-PCI MDCT and CTO PCI from three centers were included.
  • Systematic cardiac troponin (cTn) sampling was performed before and after PCI to assess for PMI.
  • Patients were stratified into groups based on post-PCI cTn elevation; MDCT findings and procedural variables were compared.

Main Results:

  • Procedure success (80.2%) was not associated with PMI.
  • PMI incidence was higher with the retrograde versus antegrade approach.
  • MDCT identified lesion length (OR: 1.04) and the napkin-ring sign (OR: 5.41) as significant predictors of PMI. The retrograde approach (OR: 4.78) was also a predictor.

Conclusions:

  • PMI is a common occurrence in patients undergoing elective CTO PCI, irrespective of procedural success.
  • Preprocedural MDCT findings, specifically lesion length and the napkin-ring sign, are significant predictors of PMI.
  • MDCT can help identify high-risk patients for PMI before CTO PCI, potentially guiding procedural strategy.

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