Impact of plaque composition on cardiac troponin elevation after percutaneous coronary intervention: an ultrasound analysis.
OBJECTIVE
We used virtual histology-intravascular ultrasound (VH-IVUS) to study the relationship between pre-percutaneous coronary intervention (PCI) coronary plaque characteristics and post-PCI cardiac troponin I (cTnI) elevation.


BACKGROUND
Percutaneous coronary intervention is often complicated by post-procedural myocardial necrosis as manifested by elevated cardiac markers.


METHODS
Eighty consecutive patients (29 stable and 51 unstable angina) with normal pre-PCI cTnI levels were imaged before PCI using VH-IVUS. Patients were divided into 2 groups according to the presence (Group I, n = 38) or absence (Group II, n = 42) of post-PCI cTnI elevation > or =3x the upper limit of normal (0.08 ng/ml).


RESULTS
The absolute and percent necrotic core volumes were significantly greater in Group I than in Group II (13.6 +/- 6.4 mm(3) vs. 7.9 +/- 4.4 mm(3), p < 0.001, and 19.8 +/- 10.4% vs. 12.8 +/- 8.4%, p = 0.015, respectively). The absolute and percent necrotic core areas were significantly greater in Group I than in Group II at the minimum lumen site (1.70 +/- 0.91 mm(2) vs. 0.61 +/- 0.39 mm(2), p < 0.001, and 22.9 +/- 11.7% vs. 10.4 +/- 6.6%, p < 0.001, respectively) and at the largest necrotic core site (2.00 +/- 0.86 mm(2) vs. 0.81 +/- 0.78 mm(2), p < 0.001, and 24.0 +/- 11.7% vs. 12.9 +/- 6.6%, p < 0.001, respectively). The DeltacTnI correlated with: 1) absolute and percent necrotic core area at the minimum lumen site and at the largest necrotic core site; 2) absolute necrotic core volume; 3) percent fibrofatty area at the minimum lumen site; and 4) lesion site plaque burden. In the multivariate analysis, absolute necrotic core area at the minimum lumen site was the only independent predictor of post-PCI cTnI elevation > or =3x the upper limit of normal (odds ratio: 1.318; 95% confidence interval: 1.090 to 1.594, p = 0.004).


CONCLUSIONS
The VH-IVUS analysis shows that post-PCI cTnI elevation occurs in lesions with a large necrotic core area. The VH-IVUS may play an important role in detecting which lesions are high risks for myocardial necrosis after PCI.
Hong
Young Joon
YJ
Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
Mintz
Gary S
GS
Kim
Sang Wook
SW
Lee
Sung Yun
SY
Okabe
Teruo
T
Pichard
Augusto D
AD
Satler
Lowell F
LF
Waksman
Ron
R
Kent
Kenneth M
KM
Suddath
William O
WO
Weissman
Neil J
NJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D009336:Necrosis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*; D018084:Ultrasonography, Interventional; D015854:Up-Regulation
D015415:Biomarkers; D019210:Troponin I