A worse prognosis of peri-procedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) has been reported in patients displaying an isolated elevation of cardiac troponin-T (TnT) or troponin-I [1,2]. Highly sensitive assay for TnT (hs-TnT) is newly developed, permitting measurement of TnT than those measurable limit with conventional assays [3,4]. Thus, procedural changes in TnT values following PCI using the hs-TnT assay may identify more minute myocardial injury. Optical coherence tomography (OCT) with high-resolution images (≈15 μm) allows detailed information such as fibrous cap thickness, and lipid distribution of the atherosclerotic plaque in vivo [5]. Therefore, this study has focused on precise assessments for PMI and lesion characteristics using both the hs-TnT measurements and OCT imaging. We enrolled 79 patients (59 males, age range: 42 to 86 years) who underwent elective coronary stent implantationwith OCTguidance for de novo atherosclerotic lesions. All patients were diagnosed as having stable angina pectoris (SAP) defined as a positive stress test for myocardial ischemia and no change in clinical symptoms within 4 weeks. The quantitative coronary angiography (QCA) findings were analyzed with a computer-assisted, automated edge detection algorithm(CMS,MEDIS, Nuenen, TheNetherlands). TheOCTprocedure has been previously reported [5]. Characterizations of the plaque components, such as lipid, fibrous, or calcified tissue and thrombus were validated based on the established criteria [6]. For all images with an OCT-determined lipid plaque, the angle of lipid tissue (AL), thinnest fibrous cap thickness (TFCT) and length of lipid tissue (LL) were measured as previously reported [5]. Blood samples were obtained before PCI and from 18 to 24 h following PCI. Serum hs-TnT was measured using an electrochemiluminescence pre-commercial immunoassay (Roche Diagnostics Ltd, Rotkreuz, Switzerland) [3]. According to the recent universal definition, the current study defined PMI as hsTnT values increased more than three times the 99th percentile upper reference limit (0.014 ng/ml) during PCI [7]. The patientswere divided into two groups, PMI and non-PMI groups. Thereafter, we analyzed which factors correspond to PMI by considering the patients' demographics, angiographic findings or lesion characteristics, and procedures. All statistical analyses were performed using the SPSS software program (version 11.0.1, SPSS Inc., Chicago, IL) and the MedCalc software package (version 10.1.4, MedCalc Software, Mariakerke, Belgium). A univariate logistic regression analysis was performed to obtain the odds ratio for PMI. Thereafter, a multivariate logistic regression analysis was performed using the variables with P values b 0.10 in the univariate analysis for examining their independent association with PMI. The receiver operating characteristic (ROC) curve analyseswereperformed to examine the ability of the OCTfindings to identify subjects at high-risk for PMI. All statistical tests were 2-sided, and a P value b 0.05 was considered to be significant. The mean patient age was higher than that of non-PMI group (71.0 ± 10.9 vs. 65.2 ± 9.7, P = 0.016), while the other baseline characteristics including coronary risk factors, prescription of pharmacological agents, lipid profile, estimated glomerular filtration rate or ejection fraction did not differ significantly between the groups. There were significant differences in the American Heart Association/American College of Cardiology's (AHA/ACC) classification (P = 0.023) and bifurcation lesions between the groups (20% vs. 5%, P = 0.013). Other angiographic parameters such as reference vessel diameter, minimum lumen diameter, or diameter stenosis were not different between the 2 groups. In a univariate logistic regression analysis (Table 1), age, AHA/ACC classification, thrombus, plaque rupture/fissure and each quartile increment in the AL, TFCT, and LL had a significantly increased odds ratio for PMI, and a International Journal of Cardiology 168 (2013) 2860–3148
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