Abstract
BackgroundPeriprocedural myocardial injury (pMI) is a common complication of elective percutaneous coronary intervention (PCI) that reduces some of the beneficial effects of coronary revascularization and impacts the risk of cardiovascular events. We developed a 3-dimensional volumetric cardiovascular magnetic resonance (CMR) method to evaluate coronary high intensity plaques and investigated their association with pMI after elective PCI.MethodsBetween October 2012 and October 2016, 141 patients with stable coronary artery disease underwent T1-weighted CMR imaging before PCI. A conventional 2-dimensional CMR plaque-to-myocardial signal intensity ratio (2D-PMR) and the newly developed 3-dimensional integral of PMR (3Di-PMR) were measured. 3Di-PMR was determined as the sum of PMRs above a threshold of > 1.0 for voxels in a target plaque. pMI was defined as high-sensitivity cardiac troponin T > 0.07 ng/mL.Results pMI following PCI was observed in 46 patients (33%). 3Di-PMR was significantly higher in patients with pMI than those without pMI. The optimal 3Di-PMR cutoff value for predicting pMI was 51 PMR*mm3 and the area under the receiver operating characteristic curve (0.753) was significantly greater than that for 2D-PMR (0.683, P = 0.015). 3Di-PMR was positively correlated with lipid volume (r = 0.449, P < 0.001) based on intravascular ultrasound.Stepwise multivariable analysis showed that 3Di-PMR ≥ 51 PMR*mm3 and the presence of a side branch at the PCI target lesion site were significant predictors of pMI (odds ratio [OR], 11.9; 95% confidence interval [CI], 4.6–30.4, P < 0.001; and OR, 4.14; 95% CI, 1.6–11.1, P = 0.005, respectively).Conclusions3Di-PMR coronary assessment facilitates risk stratification for pMI after elective PCI.Trial registrationretrospectively registered.
Highlights
Percutaneous coronary intervention (PCI) has become the most common procedure for coronary revascularization in patients with both stable and unstable coronary artery disease (CAD)
Both 3-dimensional integral (3Di)-plaque-to-myocardial signal intensity ratio (PMR) and 2dimensional PMR (2D-PMR) were significantly higher in patients with Periprocedural myocardial injury (pMI) than those without pMI (P < 0.001), age, gender, coronary risk factors, medications, and pre-percutaneous coronary intervention (PCI) hs-cTnT level were similar
Values are medians or n (%) 2D-PMR 2-dimensional plaque-to-myocardium signal intensity ratio, 3-dimensional integral of PMR (3Di-PMR) 3-dimensional integral of the plaque-to-myocardium signal intensity ratio, CSA Crosssectional area, EEM External elastic membrane, IB-Intravascular ultrasound (IVUS) Integrated backscatter intravascular ultrasound, LAD Left anterior descending coronary artery, LCX Left circumflex coronary artery, P + M Plaque plus media, PCI Percutaneous coronary intervention, PMR*mm3 the unit of 3Di-PMR; the integral of voxel volume multiplied by its PMR value > 1.0 from a coronary plaque, RCA Right coronary artery derived indices; attenuation length (0.641 [95% Confidence interval (CI), 0.539– 0.477], P = 0.038), remodeling index (0.547 [95% CI, 0.456– 0.637], P = 0.013), and prevalence of type B2/C lesion (0.525 [95% CI, 0.438–0.613], P < 0.001), bifurcation lesion (0.612 [95% CI, 0.532–0.692], P = 0.039), and calcification
Summary
Percutaneous coronary intervention (PCI) has become the most common procedure for coronary revascularization in patients with both stable and unstable coronary artery disease (CAD). PMI might reduce some of the beneficial effects of coronary revascularization. Coronary high-intensity plaques (HIPs) with a high plaque-to-myocardial signal intensity ratio (PMR) on noncontrast T1-weighted (T1w) cardiovascular magnetic resonance (CMR) imaging are associated with future coronary events and PCI-related pMI [4,5,6,7]. Current HIP-PMR evaluation is solely based on signal intensity without consideration of plaque volume, which yields a 2dimensional PMR (2D-PMR) based on a coronary plaque as a region of interest (ROI) [4, 5]. Periprocedural myocardial injury (pMI) is a common complication of elective percutaneous coronary intervention (PCI) that reduces some of the beneficial effects of coronary revascularization and impacts the risk of cardiovascular events. We developed a 3-dimensional volumetric cardiovascular magnetic resonance (CMR) method to evaluate coronary high intensity plaques and investigated their association with pMI after elective PCI
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