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Coronary artery calcium score in predicting periprocedural myocardial infarction in patients undergoing an elective
Min Gyu Kang1, Yoomee Kang1, Hyun Gyung Jang1
1Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju.
Insights
High coronary artery calcium score (CACS) measured by computed tomography coronary angiography (CTCA) predicts periprocedural myocardial infarction (PMI) in patients undergoing percutaneous coronary intervention (PCI). This increases the risk of major adverse cardiovascular events.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Periprocedural myocardial infarction (PMI) is a complication of percutaneous coronary intervention (PCI).
- Coronary artery calcium score (CACS) assessed via computed tomography coronary angiography (CTCA) may predict cardiovascular events.
Purpose of the Study:
- To determine if CACS measured by CTCA predicts PMI in patients undergoing elective PCI.
- To assess the association between CACS and major adverse cardiovascular events (MACE) post-PCI.
Main Methods:
- 197 patients with stable angina undergoing elective PCI were evaluated.
- CACS was measured using CTCA; PMI was defined by troponin I elevation post-PCI.
- Patients were followed for a median of 4.6 years for MACE.
Main Results:
- PMI occurred in 18.7% of patients, with a trend toward higher CACS in those with PMI.
- PMI prevalence correlated positively with CACS quartiles (P=0.002).
- A CACS cutoff >113 predicted PMI (OR: 5.994, P<0.001), and was an independent predictor (OR: 3.61, P=0.028).
- Patients with PMI had higher MACE rates (54.1% vs. 10.6%, P<0.001).
Conclusions:
- High CACS measured by CTCA is a significant predictor of PMI in patients undergoing elective PCI.
- PMI, predicted by CACS, is associated with worse long-term cardiovascular outcomes.
Background:
This study aimed to evaluate whether the coronary artery calcium score (CACS) measured with computed tomography coronary angiography (CTCA) predicts periprocedural myocardial infarction (PMI) in patients undergoing an elective percutaneous coronary intervention (PCI).
Patients And Methods:
A total of 197 patients with stable angina underwent elective PCI after CTCA. We evaluated CACS using CTCA and assessed the clinical risk factors for PMI. PMI was defined as an elevation of troponin I levels exceeding five times the upper limit of normal within 24 h after PCI. Patients were followed up for major adverse cardiovascular events for a median of 4.6 years.
Results:
The prevalence of PMI was 18.7% (37 patients) and patients with PMI showed a trend toward a higher CACS (721±779 vs. 498±842, P=0.142). The prevalence of PMI showed a positive correlation with the CACS distribution [8.0%, first interquartile range (IQR); 14.3%, second IQR; 22.4%, third IQR; 30.6%, fourth IQR; P=0.002]. The CACS cut-off value for PMI was greater than 113 (area under the curve: 0.670; 95% confidence interval: 0.600-0.736; P<0.001). Patients with CACS greater than 113 before PCI showed a higher prevalence of PMI (26.2 vs. 5.6%, odds ratio: 5.994; P<0.001). Multivariate analysis showed that CACS greater than 113 was the main predictor for PMI (odds ratio: 3.61, 95% confidence interval: 1.145-11.363; P=0.028). In this study, the cumulative incidence of major adverse cardiovascular event was higher in patients with PMI (54.1 vs. 10.6%; P<0.001).
Conclusion:
This study suggests that high CACS measured with CTCA influences the occurrence of PMI, which is associated with worse cardiovascular outcomes.
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