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Published on: August 28, 2018
Predictive value of plaque features quantified by coronary CT angiography for periprocedural myocardial infarction in
Zhong-Fei Lu1, Yijun Cao2, Sameer Abrol3
1Department of Radiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Beijing, People's Republic of China.
Insights
Coronary CT angiography can predict periprocedural myocardial infarction (PMI) in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients. High lipid core burden and plaque length on CCTA identify individuals at increased risk for PMI.
Area of Science:
- Cardiology
- Radiology
- Interventional Cardiology
Background:
- Periprocedural myocardial infarction (PMI) complicates percutaneous coronary intervention (PCI) and is linked to poor outcomes.
- Predictors of PMI in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients are not fully understood.
- Coronary CT angiography (CCTA) offers detailed plaque visualization, potentially aiding risk assessment.
Purpose of the Study:
- To evaluate the predictive value of CCTA-derived plaque characteristics for PMI in NSTE-ACS patients undergoing PCI.
- To identify specific CCTA plaque features associated with an increased risk of PMI.
- To assess the incremental value of CCTA plaque assessment in risk stratification for PMI.
Main Methods:
- Secondary analysis of a prospective multicenter NSTE-ACS cohort.
- Participants underwent pre-PCI CCTA; plaque components (lipid core, fibrous, calcified) were quantified.
- PMI was adjudicated using the Fourth Universal Definition; logistic regression identified predictors.
Main Results:
- PMI occurred in 14.9% of 201 NSTE-ACS patients.
- Increased lipid core burden (OR 1.05) and plaque length (OR 1.04) were independent predictors of PMI.
- Adding these features to a baseline model significantly improved risk prediction (IDI 0.11, NRI 0.60).
Conclusions:
- CCTA-quantified lipid core burden and plaque length are independently associated with PMI risk in NSTE-ACS.
- Pre-procedural CCTA plaque analysis enhances risk stratification for PMI.
- CCTA findings may guide individualized PCI strategies to mitigate PMI risk.
Abstract:
Periprocedural myocardial infarction (PMI) is associated with adverse outcomes, but determinants of its occurrence in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remain unclear. This study aimed to investigate the predictive value of plaque characteristics quantified by coronary CT angiography (CCTA) for PMI in this population. In this secondary analysis of a prospective multicenter NSTE-ACS cohort, participants who underwent CCTA before percutaneous coronary intervention were analyzed. Plaque components were defined by CT thresholds: lipid core (< 30 HU), fibrous (30-350 HU), and calcified (≥ 350 HU). Plaque characteristics were comprehensively quantified on CCTA. PMI was adjudicated according to the Fourth Universal Definition of Myocardial Infarction. A total of 201 participants (mean age 56.8 years ± 11.3 [SD]; 170 male) were included for the analysis. PMI occurred in 30 (14.9%) participants. Lipid core burden (adjusted OR: 1.05; 95% CI: 1.01-1.09; P = 0.03) and plaque length (adjusted OR: 1.04; 95% CI: 1.01-1.07; P = 0.02) were independent predictors of PMI, with optimal cutoffs of 30.6% and 45.0 mm. The addition of dichotomized lipid core burden and plaque length to a baseline model significantly improved predictive performance, as indicated by an integrated discrimination improvement (IDI) of 0.11 (P < 0.001) and a net reclassification improvement (NRI) of 0.60 (P = 0.002). In patients with NSTE-ACS, CCTA-quantified lipid core burden and plaque length were independently associated with the risk of PMI. Pre-procedural CCTA plaque assessment improves risk stratification for PMI and may aid in planning individualized PCI strategies.
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