Impact of plaque morphology on creatine kinase-MB elevation in patients with elective stent implantation.
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.
Yonetsu
Taishi
T
Cardiology, Tsuchiura Kyodo Hospital, Tsuchiura, Japan. yonetsu@gmail.com
Kakuta
Tsunekazu
T
Lee
Tetsumin
T
Takahashi
Kentaro
K
Yamamoto
Ginga
G
Iesaka
Yoshito
Y
Fujiwara
Hideomi
H
Isobe
Mitsuaki
M
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
D015415:Biomarkers; D052279:Creatine Kinase, MB Form