title: Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with non-ST segment elevation acute coronary syndrome.
abstract: OBJECTIVE
  This study aimed to use optical coherence tomography (OCT) to study the relationship between plaque morphology prior to percutaneous coronary intervention (PCI) and post-PCI cardiac troponin (cTn) elevations in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Furthermore, the relationship between these findings and the adverse cardiac events during follow-up was assessed.
  
  
  BACKGROUND
  Association between post-PCI cTn elevations and OCT findings in NSTE-ACS patients is unclear.
  
  
  METHODS
  We evaluated 167 patients with stable or falling cTn values after admission who underwent PCI. Periprocedural myocardial injury (PMI) was defined as an cTn increase of more than 70× upper limit of normal (ULN) in troponin-negative patients before PCI, or more than new 70× ULN elevation from the previous nadir level in pre-PCI troponin-positive patients. Clinical and OCT findings were compared between patients with (n = 48, 29%) and without (n = 119, 71%) PMI.
  
  
  RESULTS
  PMI was associated with age, prior PCI, low estimated glomerular filtration rate (eGFR), OCT-derived thin-cap fibroatheroma (TCFA), plaque rupture, and lipid length. In multivariable analysis, TCFA (odds ratio [OR], 2.88; P = 0.011), eGFR (OR, 0.97, P = 0.003), and lipid length (OR, 1.12, P = 0.020) were independent predictors of PMI. At a median follow-up of 38 months, event-free survival was significantly worse in patients with PMI (log-rank test χ2= 6.47, P = 0.011).
  
  
  CONCLUSIONS
  OCT analysis showed that PMI occurs more frequently in lesions with TCFA in NSTE-ACS patients, and may identify patients having a higher risk of adverse cardiac events during follow-up. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.|Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Tetsumin
authors.identifier: http://orcid.org/0000-0002-9457-072X
authors.initials: T
authors.lastname: Lee
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Murai
authors.affiliation: Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
authors.affiliation: Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D000368:Aged; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D041623:Tomography, Optical Coherence / Q000379:methods*
chemical_list: D015415:Biomarkers
keywords: myocardial infarction; optical coherence tomography; troponin