Impact of Coronary Plaque Composition on Cardiac Troponin Elevation After Percutaneous Coronary Intervention in Stable Angina Pectoris: A Computed Tomography Analysis

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• 作者：Hiroaki Watabe ; MD ; Akira Sato ; MD ; ^{asato@md.tsukuba.ac.jp} ; Daiki Akiyama ; MD ; Yuki Kakefuda ; MD ; Toru Adachi ; MD ; Eiji Ojima ; MD ; Tomoya Hoshi ; MD ; Nobuyuki Murakoshi ; MD ; PhD ; Tomoko Ishizu ; MD ; PhD ; Yoshihiro Seo ; MD ; Kazutaka Aonuma ; MD ; PhD
• 关键词：coronary plaque ; multidetector computed tomography ; stents ; troponin
• 刊名：Journal of the American College of Cardiology
• 出版年：2012
• 出版时间：22 May, 2012
• 年：2012
• 卷：59
• 期：21
• 页码：1881-1888
• 全文大小：753 K

文摘

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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 ? 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 ¡À 0.18 vs. 1.04 ¡À 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.