title: Impact of plaque morphology on creatine kinase-MB elevation in patients with elective stent implantation.
abstract: BACKGROUND
  The association between percutaneous coronary intervention (PCI) and subsequent myonecrosis has been widely recognized, and worse prognosis has been reported among patients with elevated post-PCI biomarkers. We used optical coherence tomography (OCT) to study the relationship between pre-PCI plaque morphology and post-PCI creatine kinase-MB (CK-MB) elevation.
  
  
  METHODS
  One hundred and twenty-five patients with normal pre-PCI CK-MB levels underwent OCT examination before nonemergency stent implantation. Patients were divided into two groups according to the presence (Group CK, n=35) or absence (Group NCK, n=90) of post-PCI CK-MB elevation ≥ upper limit of the normal range. Clinical and the OCT findings were compared between the two groups.
  
  
  RESULTS
  Elevated CK-MB levels was observed in 35 patients (28%). The CK-MB elevation was associated with elevated white blood cell count, type B2/C lesions, the presence of thin cap fibroatheroma (TCFA), plaque rupture, and lipid quadrants. In the multivariate analysis, the presence of TCFA (OR 4.68, 95% CI 1.88-11.64, p=0.001) and type B2/C lesions (OR 4.20, 95% CI 1.30-13.59, p=0.02) were independent predictors of post-PCI CK-MB elevation.
  
  
  CONCLUSIONS
  TCFA and angiographically complex lesion morphology can predict post-PCI CK-MB elevation in patients treated with elective stent implantation. OCT may be useful in stratifying the risk for nonemergency stent implantation.
authors.affiliation: Cardiology, Tsuchiura Kyodo Hospital, Tsuchiura, Japan. yonetsu@gmail.com
authors.forename: Taishi
authors.initials: T
authors.lastname: Yonetsu
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
authors.forename: Tetsumin
authors.initials: T
authors.lastname: Lee
authors.forename: Kentaro
authors.initials: K
authors.lastname: Takahashi
authors.forename: Ginga
authors.initials: G
authors.lastname: Yamamoto
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
authors.forename: Hideomi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000097:blood* / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D041623:Tomography, Optical Coherence / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D052279:Creatine Kinase, MB Form