title: Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with elective stent implantation.
abstract: BACKGROUND
  Mild elevations of cardiac troponin frequently occur after percutaneous coronary intervention (PCI), and patients with elevated post-PCI biomarkers have a worse prognosis. We used optical coherence tomography (OCT) to study the relationship between pre-PCI plaque morphology and post-PCI cardiac troponin I elevations.
  
  
  RESULTS
  One hundred thirty-one patients with normal pre-PCI cardiac troponin I levels underwent OCT before nonemergency stent implantation. Clinical and OCT findings were compared between patients with (n=31, 23.7%) and without (n=100, 76.3%) post-PCI cardiac troponin I of >3 × upper reference limit (post-PCI myocardial infarction [MI]). After PCI, long-term follow-up data were collected. Post-PCI MI was associated with angiographic lesion length, type B2/C lesions, presence of thin-cap fibroatheroma, and fibrous cap thickness. In multivariable analysis, presence of thin-cap fibroatheroma (odds ratio, 10.47; 95% confidence interval, 3.74 to 29.28; P<0.001) and type B2/C lesions (odds ratio, 3.74; 95% confidence interval, 1.41 to 9.92; P=0.008) were predictors of post-PCI MI. At a median follow-up of 12 months, cardiac event-free survival was significantly worse in patients with post-PCI MI (log-rank test χ(2)=8.9; P=0.003). Cox proportional hazards analysis showed that post-PCI MI (hazard ratio, 3.67; 95% confidence interval, 1.39 to 9.65; P=0.009) and ejection fraction (hazard ratio, 0.96; 95% confidence interval, 0.92 to 0.99; P=0.029) were independent predictors of adverse cardiovascular events during follow-up.
  
  
  CONCLUSIONS
  Type B2/C lesions and the presence of OCT-defined thin-cap fibroatheroma can predict post-PCI MI in patients treated with elective stent implantation, who may require adjunctive therapy after otherwise successful PCI.
authors.affiliation: Department of Cardiology, Tsuchiura Kyodo General Hospital, 11-7 Manabeshin-machi, Tsuchiura, Japan.
authors.forename: Tetsumin
authors.initials: T
authors.lastname: Lee
authors.forename: Taishi
authors.initials: T
authors.lastname: Yonetsu
authors.forename: Kenji
authors.initials: K
authors.lastname: Koura
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hishikari
authors.forename: Tadashi
authors.initials: T
authors.lastname: Murai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Iwai
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Takagi
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
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D050197:Atherosclerosis / Q000175:diagnosis* / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D015415:Biomarkers / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000473:pathology; D011379:Prognosis; D011446:Prospective Studies; D019919:Prosthesis Implantation; D015607:Stents / Q000706:statistics & numerical data; D041623:Tomography, Optical Coherence; D019210:Troponin I / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D019210:Troponin I