Occurrence Of Periprocedural Myocardial Infarction Research Articles

Temporal Trends in In-Hospital Outcomes Following Unprotected Left-Main Percutaneous Coronary Intervention: An Analysis of 14 522 Cases From British Cardiovascular Intervention Society Database 2009 to 2017

Percutaneous coronary intervention (PCI) is increasingly used as a treatment option for unprotected left main stem artery (unprotected left main stem percutaneous intervention) disease. However, whether patient outcomes have improved over time is uncertain. Using the United Kingdom national PCI database, we studied all patients undergoing unprotected left main stem percutaneous intervention between 2009 and 2017. We excluded patients who presented with ST-segment-elevation, cardiogenic shock, and with an emergency indication for PCI. Between 2009 and 2017, in the study-indicated population, 14 522 unprotected left main stem percutaneous intervention procedures were performed. Significant temporal changes in baseline demographics were observed with increasing patient age and comorbid burden. Procedural complexity increased over time, with the number of vessels treated, bifurcation PCI, number of stents used, and use of intravascular imaging and rotational atherectomy increased significantly through the study period. After adjustment for baseline differences, there were significant temporal reductions in the occurrence of peri-procedural myocardial infarction (P<0.001 for trend), in-hospital major adverse cardiac or cerebrovascular events (P<0.001 for trend), and acute procedural complications (P<0.001 for trend). In multivariable analysis examining the associates of in-hospital major adverse cardiac or cerebrovascular events, while age per year (odds ratio, 1.02 [95% CIs, 1.01-1.03]), female sex (odds ratio, 1.47 [1.19-1.82]), 3 or more stents (odds ratio, 1.67 [05% [1.02-2.67]), and patient comorbidity were associated with higher rates of in-hospital major adverse cardiac or cerebrovascular events, by contrast use of intravascular imaging (odds ratio, 0.56 [0.45-0.70]), and year of PCI (odds ratio, 0.63 [0.46-0.87]) were associated with lower rates of in-hospital major adverse cardiac or cerebrovascular events. Despite trends for increased patient and procedural complexity, in-hospital patient outcomes have improved after unprotected left main stem percutaneous intervention over time.

Impact of increased inflammation biomarkers on periprocedural myocardial infarction in patients undergoing elective percutaneous coronary intervention: a cohort study.

BackgroundThe fact that each inflammatory indicator has a forecasting capacity on the occurrence of periprocedural myocardial infarction (PMI) has a controversial existence. The purpose of this study was to explore the role of inflammation biological indicators on PMI in a group of patients undergoing selective percutaneous coronary intervention (PCI).MethodsThe study was carried out both in a retrospective and prospective manner in 7,413 and 1,189 subjects, respectively. In the retrospective cohort study, the association between inflammation biomarkers and PMI was assessed by univariate and multivariate logistic regression. WBC, CRP, and NLR were distributed using k-means clustering into a virtual variable “Inflammatory Trend”, and multivariate logistic regression and subgroup analysis were performed. In the prospective cohort study, the endpoints were PMI, cardiovascular death or cardiac arrest. The chi-square test was performed to calculate the relative risk (RR).ResultsIn the retrospective cohort study, except WBC, CRP, NLR and virtual variable “Inflammatory trend” were independent risk factors for PMI. The subgroup analysis revealed that CRP can serve as the most stable predictor. In the prospective cohort study, WBC (RR =1.134, P=0.416) has no effect on the incidence of PMI. However, an elevation in the incidence of PMI was observed with an increase of NLR (RR =1.354, P=0.041) and CRP (RR =1.412, P=0.025).ConclusionsIn patients with elective PCI for single-vessel lesions, high CRP increases the risk for PMI. The increase of NLR was an independent risk factor for PMI, especially for patients with hypertension and under the age of 70. WBC has no influence on the occurrence of PMI.

Impact of periprocedural biomarker elevation on mortality in stable angina pectoris patients undergoing elective coronary intervention: a systematic review and meta-analysis including 24 666 patients.

Uncertainty remains regarding the exact prognostic impact of biomarker elevation following percutaneous coronary intervention in patients with stable angina pectoris and the subsequent risk of death. We sought, therefore, to evaluate the effect of periprocedural myocardial infarction on the subsequent mortality risk following percutaneous coronary intervention in patients with stable angina pectoris and normal preprocedural cardiac biomarkers level. After a systematic literature search was done in PubMed and EMBASE, we performed a meta-analysis of studies with post-procedural cardiac biomarkers data. All-cause mortality and cardiac death were evaluated in subjects with stable angina pectoris who underwent an elective coronary intervention. Fourteen studies with 24 666 patients were included. The mean age was 64.2 years ± 9.8 with about 3-quarters (74.9%) of these patients being men. The mean duration of follow-up was 18.1 months ± 14.3. Periprocedural myocardial infarction, based on study-specific biomarker criteria, occurred in 14.3% of the patients. Periprocedural myocardial infarction conferred a statistically significant increase in the risk of all-cause mortality (odds ratio, 1.62; 95% confidence interval, 1.30-2.01; P < 0.0001; I = 0%); where reported separately, cardiac death was also significantly increase (odds ratio, 2.77; 95% confidence interval, 1.60-4.80; P = 0.0003; I = 0%). The occurrence of periprocedural myocardial infarction after an elective percutaneous coronary intervention in patients with stable angina pectoris is associated with a statistically significant increase in subsequent all-cause mortality and cardiac mortality.

Intracoronary thrombus by Optical Coherence Tomography (OCT): Characterization, quantification and prognostic impact in patients with non-ST-elevation acute coronary syndrome. A DOCTORS substudy

We evaluated the impact of thrombus burden as measured by Optical Coherence Tomography on the occurrence of periprocedural myocardial infarction (type IVa MI) in pts undergoing percutaneous coronary intervention (PCI) in non ST elevation acute coronary syndrome (NSTE-ACS). Prospective multicenter study including pts treated for NSTE-ACS (< 72 h) undergoing PCI of the infarct related artery (IRA). OCT was performed before and after PCI. Thrombus burden was measured quantitatively by planimetry, and semi-quantitatively by the OCT thrombus score. Primary endpoint was the rate of type IVa MI. Secondary endpoints were the relationship between OCT characteristics of the IRA and volume of thrombus, correlation between thrombus volume measured pre-PCI and functional outcome of the angioplasty evaluated by fractional flow reserve (FFR) post-procedure. Hundred and twenty pts aged 60.8 ± 11 years were included. Thrombus was more frequently present on OCT [83 (69%)] than on angiography [54 (45%), P < 0.0001]. Type IVa MI occurred in 48 pts (40%). The occurrence of type IVa MI was not related to presence of thrombus on OCT (33 (40%) with vs. 15 without (41%) P = 0.93). Thrombus volume evaluated by planimetry or semi-quantitavely did not predict type IVa MI. There was a strong association between presence of thrombus pre-PCI and presence of tissue prolapse post-PCI. The volume of thrombus was significantly correlated with the volume of tissue prolapse ( P = 0.03 and P = 0.01). The presence of thrombus and volume of thrombus as measured pre-PCI did not affect post-PCI FFR (0.94 ± 0.04 vs. 0.93 ± 0.04, for presence vs. absence of thrombus, P = 0.51). OCT allows better visualization of thrombus than angiography in NSTE-ACS. In pts receiving antithrombotic therapy, neither the presence nor the volume of thrombus impacts the occurrence of a periprocedural myocardial infarction. Thrombus burden does not influence the functional outcome of angioplasty as measured by FFR.

EVALUATION OF INTRACORONARY THROMBUS BY OPTICAL COHERENCE TOMOGRAPHY (OCT): CHARACTERIZATION, QUANTIFICATION AND PROGNOSTIC IMPACT IN PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROME - A DOCTORS SUBSTUDY

We aimed to evaluate the impact of thrombus burden as measured by Optical Coherence Tomography on the occurrence of peri-procedural myocardial infarction (type IVa MI) among patients undergoing percutaneous coronary intervention (PCI) in non ST elevation acute coronary syndrome (NSTE-ACS).

Impact of pre-procedural dual antiplatelet therapy on periprocedural myocardial infarction in patients undergoing percutaneous coronary interventions with adjunctive tirofiban

BackgroundRecent trials have failed to demonstrate any clinical benefit from pre-treatment with dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary interventions, (PCI), even in the setting of acute coronary syndrome. However, suboptimal platelet inhibition during (PCI) has been shown to enhance the risk of acute ischemic complications, such as stent thrombosis and periprocedural myocardial infarction (PMI), thus raising the attention on the potential advantages of adjunctive glycoprotein IIbIIIa inhibitors to obviate to the delayed onset of action of oral antiplatelet drugs. The aim of the present study was then to evaluate the impact of platelet reactivity and pre-procedural DAPT on PMI in patients undergoing PCI with adjunctive tirofiban. MethodsIn a consecutive cohort of patients undergoing PCI with tirofiban (intracoronary/intravenous ± prolonged infusion), periprocedural myonecrosis was defined as troponin I increase by 3 times the ULN or by 50% of an elevated baseline value, whereas PMI as CKMB increase by 3 times the ULN or 50% of baseline. Platelet function was assessed by impedance aggregometry. ResultsA total of 168 patients were included, 77 (45.8%) of whom were on DAPT at the time of PCI. Patients on DAPT had more often a history of previous PCI (p = 0.03), higher ACS at admission (p < 0.001) and creatinine levels (p = 0.03). Coronary calcifications and type C lesions were more frequent in patients without DAPT (p = 0.02 and p = 0.03, respectively), as much as TIMI flow < 3 (p = 0.03), while procedural characteristics were comparable. Baseline platelet reactivity was significantly reduced in DAPT treated patients (p < 0.001 for ASPI, COL and ADP tests). However the rate of periprocedural myonecrosis did not differ according to pre-procedural DAPT (68.4%vs 67%, p = 0.87; adjusted OR[95%CI] = 1.34[0.71–2.53], p = 0.36) and neither the occurrence of PMI (13.3% vs 12.6%, p = 0.99; adjusted OR[95%CI] = 1.24[0.51–3.1], p = 0.64). Furthermore, baseline platelet reactivity was similar in patients with and without PMI/myonecrosis with no relationship between platelet function and Troponin I peak. ConclusionIn patients undergoing PCI with adjunctive GP IIb-IIIa inhibitors, preprocedural DAPT and baseline platelet reactivity are not associated to the risk of periprocedural myocardial infarction or myonecrosis. These data further support the role of periprocedural Gp IIb-IIIa inhibitors in order to overcome any suboptimal inhibition of platelet aggregation at the time of the procedure due to drug-resistance or delayed (downstream) administration of ADP antagonists, especially in complex high-risk procedures.

Relation of Platelet Indexes to Platelet Reactivity and Periprocedural Myocardial Infarction in Patients Who Underwent Percutaneous Coronary Angioplasty

No comprehensive data are available on the role of platelet indexes (PI) in the periprocedural risk stratification of patients who underwent percutaneous coronary intervention (PCI). The aim of this study was to investigate the relation of PI to platelet reactivity (PR) and periprocedural myocardial infarction (PMI) in patients receiving PCI. A total of 502 PCI patients had preprocedural measurement of PI and PR, the latter assessed by VerifyNow P2Y12 assay. Study end points were incidence of PMI and high platelet reactivity (HPR) according to tertiles of PI and evaluation of PI in HPR patients. Incidence of PMI in the overall population was 6.6%. Rates of PMI were not different in PI tertiles: platelet count (I: 6.0%, II: 7.1%, III: 6.5%; p = 0.74), mean platelet volume (MPV, I: 6.6%, II: 7.3%, III: 5.8%;p = 0.86), platelet distribution width (I: 7.2%, II: 7.2%, III: 5.8%;p = 0.74), and MPV/P ratio (I: 6.6%, II: 6.0%, III: 7.1%; p = 0.91). The occurrence of PMI was significantly different in PR tertiles (I: 3%, II: 5.4%, III: 11.4%; p = 0.006). Platelet count and MPV/P ratio were significantly different in patients with and without HPR (221.8 ± 58.6 × 103/µL vs207 ± 59.4 × 103/µL, p = 0.008; 51.73 ± 15.17 vs 56.7 ± 18.3, p = 0.002).In conclusion, this study showed no relation between PI and PMI in PCI patients but confirms the association of HPR with increased incidence of PMI; thus, PI seem to be not able to identify patients at higher periprocedural risk, but monitoring PR by a bedside assay remains a useful tool for risk stratification.

Differential Rates and Clinical Significance of Periprocedural Myocardial Infarction After Stenting or Bypass Surgery for Multivessel Coronary Disease According to Various Definitions

ObjectivesThis study sought to estimate the differential incidence and prognostic significance of periprocedural myocardial infarction (MI) according to various definitions. BackgroundIn trials comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), the primary composite endpoint is very sensitive to the definition of MI. Especially, the definition of periprocedural MI has considerably varied, and uniform criteria are still unsettled. MethodsWe evaluated 7,697 patients with multivessel disease who received PCI (n = 4,514) or underwent CABG (n = 3,183) between 2003 and 2013, and for whom serial measurement of creatine kinase-MB was available. According to various MI definitions (second and third universal definitions and the Society for Cardiovascular Angiography and Interventions definition), we assessed the prevalence and prognostic significance of periprocedural MI after both PCI and CABG. Patients were followed for major cardiovascular events (death from cardiovascular causes and spontaneous MI) and death for a median of 4.7 years. ResultsAccording to various definitions of MI, there was a substantial difference in the rates of periprocedural MI after PCI and CABG (18.7% vs. 2.9% by second universal; 3.2% vs. 1.9% by third universal; and 5.5% vs. 18.3% by Society for Cardiovascular Angiography and Interventions definition). The presence of periprocedural MI was associated with increased risks of major cardiovascular events after both PCI and CABG regardless of MI definition. The risk-adjusted 5-year rates of future major cardiovascular events after occurrence of periprocedural MI were similar after PCI and CABG in second and third universal definition. However, using Society for Cardiovascular Angiography and Interventions definition, the rates of major cardiovascular events were significantly higher after PCI than after CABG (24.3% vs. 20.4%; hazard ratio: 1.61; 95% confidence interval: 1.07 to 2.41; p = 0.02). ConclusionsThere were substantial differences in incidence and clinical relevance of periprocedural MI according to various contemporary, widely used definitions of MI.

Impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris at 6 months follow-up

BackgroundWe explored the impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris (SAP) at 6months follow-up. MethodsFrom May 2015 to April 2016, a total of 746 patients with SAP were divided to high glycemic variability group (H group) (n=261) and low glycemic variability group (L group) (n=485). The primary end point was incidence of periprocedural myocardial infarction and MACE at 6months follow-up. ResultsThe occurrence of periprocedural myocardial infarction occurred in 18.8% of patients in H group and in 12.4% in L group (P=0.03). The incidence of MACE at 6months follow-up was 9.6% in H group and 4.5% in L group (P=0.01). Multivariable analysis suggested that high glycemic variability conferred a 53% risk increment of 6months follow-up MACE (odds ratio 2.13, 95% confidence interval 1.85–5.38; P=0.01). ConclusionsThe trial shows that higher blood glucose variability was correlated with higher incidence of periprocedural myocardial infarction and MACE at 6months follow-up.

Relation of Neutrophil to Lymphocyte Ratio With Periprocedural Myocardial Damage in Patients Undergoing Elective Percutaneous Coronary Intervention

Neutrophil to lymphocyte ratio (NLR) has been proposed as a marker of cardiovascular risk. The potential relation between NLR and periprocedural myocardial damage after percutaneous coronary intervention (PCI) is unclear. We enrolled 502 consecutive patients with stable coronary artery disease undergoing elective PCI. Blood samples were drawn in all patients at baseline, 6 hours, and 24 hours after PCI for complete blood cell count and cardiac biomarkers (creatine kinase-MB and troponin T [Tn-T]) assessment. NLR was calculated as the ratio between the absolute number of neutrophil over the absolute number of lymphocyte. Periprocedural myocardial infarction (PMI) was defined according to the 2012 universal definition of myocardial infarction. In the overall population, a significant postprocedural increase in NLR was observed (3.255 [2.763 to 3.995] at baseline, 4.430 [3.390 to 6.020] at 6hours, 4.720 [3.940 to 5.750] at 24 hours, p <0.0001). PMI occurred in 33 patients (6.6%). Baseline NLR was similar in patients with and without PMI (3.250 [2.820 to 3.885] vs 3.260 [2.750 to 4.000], p= 0.898); however, patients who developed PMI showed significantly higher NLR both at 6 hours (5.750 [4.360 to 9.095] vs 4.370 [3.370 to 5.950], p <0.001) and 24hours (5.180 [4.440 to 8.065] vs 4.670 [3.920 to 5.710], p= 0.003). Among patients who developed PMI, periprocedural NLR increase showed a moderate positive correlation with both creatine kinase-MB (rho= 0.377, p= 0.031) and troponin T increase (rho= 0.506, p= 0.003). In conclusion, preprocedural NLR values do not impact on the occurrence of PMI during elective PCI; however, PCI procedures induce a significant increase in NLR that seems to be proportional to the magnitude of periprocedural myocardial damage.

Impact of neutrophil-to-lymphocyte ratio on periprocedural myocardial infarction in patients undergoing non-urgent percutaneous coronary revascularisation.

BackgroundPro-thrombotic conditions importantly influence myocardial perfusion and procedural results after percutaneous coronary intervention (PCI). The neutrophil-to-lymphocyte ratio (NLR) has emerged as a predictor of cardiovascular events and of long-term prognosis, especially in ST-elevation myocardial infarction patients undergoing primary PCI. The aim of our study was to evaluate the role of NLR on periprocedural myocardial infarction (MI) in patients undergoing non-urgent PCI.MethodsIn a consecutive cohort of 1542 patients undergoing PCI, myonecrosis biomarkers were determined at 6, 12, 24 and 48 hours post-procedure. Patients were divided into quintiles according to NLR values. Periprocedural myonecrosis was defined as a troponin I increase of 3 times the upper limit of normal or as 50 % of an elevated baseline value, whereas periprocedural MI was defined as a CK-MB increase of 3 times the upper limit of normal or 50 % of baseline.ResultsHigher NLR was related to age, established risk factors and cardiovascular history. NLR was associated with severe coronary artery disease (p = 0.009), tighter stenosis (p < 0.001), coronary calcifications (p = 0.005), intracoronary thrombus or thrombectomy use (p < 0.001), TIMI flow pre- and post-PCI (p < 0.001), and inversely to restenosis (p = 0.04) and use of a drug-eluting stent (p = 0.001). NLR did not influence the occurrence of myonecrosis (p = 0.75; adjusted OR (95 % CI) = 0.99 (0.63–1.54), p = 0.96), but was associated with a higher occurrence of periprocedural MI, even after correction for baseline differences (p = 0.03; adjusted OR (95 % CI) = 1.33 (1.02–2.3), p = 0.02), with NLR ≥ 3 best predicting the risk of periprocedural MI at the receiver operating characteristic curve analysis.ConclusionIn patients undergoing non-urgent PCI, a higher NLR increases the risk of periprocedural MI, especially for values ≥ 3.

The index of microcirculatory resistance in the physiologic assessment of the coronary microcirculation.

The coronary microcirculation plays a critical role in normal cardiac physiology as well as in many disease states. However, methods to evaluate the function of the coronary microvessels have been limited by technical and theoretical issues. Recently, the index of microcirculatory resistance (IMR) has been proposed and validated as a simple and specific invasive method of assessing the coronary microcirculation. By relying on the thermodilution theory and using a pressure-temperature sensor guidewire, IMR provides a measurement of the minimum achievable microcirculatory resistance in a target coronary artery territory, enabling a quantitative assessment of the microvascular integrity. Unlike indices such as coronary flow reserve, IMR is highly reproducible and independent of hemodynamic changes. In ST-elevation myocardial infarction, IMR predicts myocardial recovery and long-term mortality, whereas in patients with stable coronary artery disease, preintervention IMR predicts the occurrence of periprocedural myocardial infarction. Increasingly, research has focused on IMR-guided interventions of the microcirculation, with the aim of preventing and/or treating the microcirculatory dysfunction that commonly accompanies the epicardial coronary disease. In the present review, we will discuss the theoretical and practical basis for IMR, the clinical studies supporting it, and the future lines of research using this novel tool.

The Effect of High Dose Cilostazol and Rosuvastatin on Periprocedural Myocardial Injury in Patients with Elective Percutaneous Coronary Intervention.

The aim of our study was to assess the effect of pretreatment with cilostazol and rosuvastatin combination before elective percutaneous coronary intervention (PCI) on peri-procedural myocardial injury (PPMIJ). We randomly assigned 172 patients with stable angina pectoris scheduled for elective PCI to pre- treatment with Cilostazol 200mg and Rosuvastatin 40 mg (group 1), or to pretreatment with Rosuvastatin 40 mg group (group 2). The primary end-point was the occurrence of PPMIJ defined as any cardiac troponin I (Tn I) level elevated above the upper normal limit (UNL). The occurrence of peri-procedural myocardial infarction (PPMIN) was defined as a post-procedural increase in cTnI level ≥ 5 times above the UNL. There was no significant difference in baseline characteristics between group 1 (n = 86) and group 2 (n = 86). The rate of PPMIJ (21% vs. 24%, p = 0.58) and PPMIN (2.3% vs. 7%, p = 0.27) were similar between the two study groups. Subgroup analysis performed on those patients without statin therapy before PCI (53 patients in group 1 and 50 patients in group 2) showed that the incidence of PPMIJ was significantly lower in the group 1 patients without chronic statin treatment [17% (9/53) versus 34% (17/50); p = 0.04], but the rate of PPMIN was similar between the two groups for those patients without chronic statin treatment [1.9% (1/53) versus 10% (5/50); p = 0.07]. We found that adjunct cilostazol and rosuvastatin pre-treatment did not significantly reduce PPMIJ after elective PCI in patients with stable angina pectoris. However, adjunct cilostazol pre-treatment could reduce PPMIJ in patients without chronic statin therapy before elective PCI. Cilostazol; Myocardial injury; Percutaneous coronary intervention; Statin.

Periprocedural use of tirofiban in elective percutaneous coronary intervention for long coronary lesions in stable patients with overlapping drug-eluting stents--the PETITION study: a prospective, randomized, multicenter study.

Patients are at risk of developing periprocedural myonecrosis after percutaneous coronary intervention (PCI). We investigated whether the use of the platelet glycoprotein (GP) IIb/IIIa receptor inhibitor tirofiban could reduce periprocedural myocardial infarction (PMI) in patients with stable coronary artery disease undergoing elective PCI with overlapping stent implantation for long lesions. A total of 748 stable angina patients with long lesions (≥ 40 mm in length) treated with overlapping stent implantation were randomly assigned to receive tirofiban (tirofiban group; n = 373) or conventional therapy (control group; n = 375). Intravenous tirofiban was initiated before PCI and maintained for 12 hr after the procedure. The primary endpoint was PMI, defined as an elevation in CK-MB > 3 times the upper limit of normal 12 hr after the index procedure. The secondary endpoint was major adverse cardiac events (MACE), including cardiac death, target vessel revascularization, and recurrent MI (re-MI), at one-year of clinical follow-up. The safety end-points included Thrombolysis in Myocardial Infarction (TIMI) major bleeding and stent thrombosis. Despite comparable angiographic and procedural characteristics, in the intention-to-treatment analysis, the primary endpoint was significantly reduced in the tirofiban group (4.0% vs. 11.5%, P < 0.001). Multivariate analysis revealed that the adjunctive use of tirofiban was the only negative predictor of PMI (OR 0.41, 95% CI 0.28-0.81, P < 0.01). At one-year of clinical follow-up, the overall occurrence of MACE was significantly lower in the tirofiban group (13.4% vs. 22.7%, P = 0.001). The rate of TIMI major bleeding and stent thrombosis did not differ significantly between the two groups. Our results show that the adjunctive use of tirofiban reduces the occurrence of PMI and MACE at one year in stable coronary artery disease patients undergoing elective PCI for long lesions with overlapping stent implantation.

Abstract 13746: Relationships between Neointimal Tissue Characteristics and Occurrence of Periprocedural Myocardial Infarction in Lesions with In-Stent Restenosis

Background: Recent studies have reported several types of neointimal tissues including neoatherosclerotic progression in stent restenosis. However, the influence of neointimal tissue characteristics on outcomes after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) remains unclear. Periprocedural myocardial infarction (PMI) is related to poor outcomes after PCI. We assessed relationships neointimal tissue characteristics and occurrence of PMI after PCI in ISR lesions. Methods: We investigated 45 ISR lesions in 45 stable angina pectoris (SAP) patients who underwent pre- and post-PCI coronary angioscopy (CAS) and optical coherence tomography (OCT) examination. We excluded patients with hemodialysis. All lesions were divided into lesions with PMI, defined as high-sensitivity cardiac troponin-T (hs-cTnT) values after PCI ≥5 times of the upper reference limit in patients with normal baseline values or ≥5 times of baseline values if hs-cTnT values were elevated before PCI, and those without. Clinical and lesion characteristics including intrastent neointimal tissues were compared between two groups. Results: PMI was observed in 15 (33.3%) lesions. Clinical characteristics including stent types and terms after stenting were similar between lesions with and without PMI. CAS analysis showed higher frequency of white neointimal proliferation with irregular surface or yellow neointima at the culprit site before PCI (86.7% vs. 43.3%, p=0.009) and atheromatous appearance (CAS-AP), defined as yellow plaque including complex thrombi underneath disrupted neointimal coverage after ballooning (66.7% vs. 16.7%, p=0.003) in lesions with PMI than those without. OCT analysis demonstrated higher frequency of heterogeneous neointima or neointimal thin-cap fibroatheroma in lesions with PMI (73.3% vs. 33.3%, p=0.02). Multivariate analysis including clinical and lesion characteristics and procedural results showed CAS-AP as an independent predictor for occurrence of PMI (odds ratio:6.90, 95% CI:1.68-28.41, p=0.008). Conclusions: In ISR lesions with SAP patients, the assessment of neointimal tissue characteristics by using CAS and OCT images may be useful for the prediction of occurrence of PMI.

Abstract 16535: Clinical Significance of Echo-Attenuated Plaque on Intravascular Ultrasound in Patients With Stable Angina Pectoris

Background: Several studies have reported that echo-attenuated plaque (EA) on intravascular ultrasound (IVUS) was related to poor outcomes after percutaneous coronary intervention (PCI) in acute coronary syndrome. However, its clinical significance and influence on outcomes in patients with stable angina pectoris (SAP) has not been fully clarified. We investigated relationships of EA on IVUS with other plaque morphologies and outcomes after PCI in SAP patients. Methods: We investigated 127 de-novo lesions in 127 SAP patients with normal pre-PCI cardiac troponin-T level (cTnT &lt;0.014ng/ml), who underwent pre-PCI IVUS and optical coherence tomography (OCT) examination. All lesions were divided into lesions with and without EA on IVUS. The occurrence of periprocedural myocardial infarction (PMI) was defined by elevation of cTnT level at 24h after PCI ≥5 times the upper limit of normal range. Plaque morphologies on IVUS and OCT were compared between the two groups. Further, we investigated the independent predictors for occurrence of PMI by multivariate analysis. Results: EA was observed in 34 (26.8%) lesions. Lesions with EA had greater vessel area (15.8±4.9 vs. 12.7±4.0 mm2, p=0.002), plaque burden (83.9±7.2 vs. 78.6±8.6%, p&lt;0.001) and remodeling index (1.19±0.25 vs. 1.00±0.24, p&lt;0.001) on IVUS than those without EA. OCT analysis showed greater lipid arc (213±80 vs. 155±99 degree, p=0.001), thinner fibrous cap thickness (182±109 vs. 231±114 μm, p=0.03), higher frequency of thin-cap fibroatheroma (23.5 vs. 7.5%, p=0.03), and white thrombus (29.8 vs. 9.7%, p=0.004) in lesions with EA. Lesions with EA had calcified plaques with smaller arc (92.6±45.4 vs. 144±88 degree, p=0.005) and thinner thickness (388±151 vs. 623±265 μm, p&lt;0.001) on OCT than those without EA. Multivariate analysis including clinical, lesion characteristics and procedural results revealed that EA on IVUS remained an independent predictor for PMI (odds ratio 4.49, 95% confidence interval 1.72-11.73, p=0.002). Conclusions: In SAP lesions, presence of EA on IVUS may suggest the existence of unstable plaque compositions and may predict for occurrence of PMI.

Eosinophils count and periprocedural myocardial infarction in patients undergoing percutaneous coronary interventions

BackgroundEosinophils have been involved in a wide spectrum of pro-inflammatory and pro-thrombotic conditions, with the development of cardiovascular complications in a significant proportion of hypereosinophilic patients. However, no study has so far evaluated the impact of eosinophils levels on periprocedural myocardial infarction (PMI) in patients undergoing non-urgent percutaneous coronary interventions (PCI), that was, then, aim of current study. MethodsIn a consecutive cohort of patients, myonecrosis biomarkers were dosed at intervals from 6 to 48 h after PCI. Periprocedural myonecrosis was defined as troponin I increase by 3 times the ULN or by 50% of an elevated baseline value, whereas PMI as CKMB increase by 3 times the ULN or 50% of baseline. ResultsOur population is represented by 1543 patients who were divided according to tertiles of absolute eosinophils count (AEC ≤ 0.1; 0.1–0.2; >0.2 × 10ˆ3/ml). Higher AEC was related to male gender (p = 0.002), arterial hypertension (p = 0.02), diabetes (p = 0.001), previous coronary revascularization (p = 0.003 for PCI, p = 0.03 for CABG), treatment with ARBs, beta-blockers, diuretics and ASA (p < 0.001), statins (p = 0.02), calcium antagonists (p = 0.05), glycosylated hemoglobin (p < 0001), creatinine levels (p = 0.001) and platelet count (p = 0.01), while inversely with acute presentation (p < 0.001), glycemia (p = 0.03), HDL-cholesterol and C-reactive protein (p = 0.02). AEC related with multivessel coronary artery disease (p = 0.05), lesion length (p = 0.01), drug eluting stents implantation (p = 0.001) and use of kissing balloon technique (p = 0.05), while inversely to intracoronary thrombus (p < 0.001) and thrombectomy (p = 0.04).AEC did not influence the occurrence of PMI (p = 0.06, adjusted OR [95% CI] = 1.06 [0.86–1.31], p = 0.57) or myonecrosis (p = 0.15, adjusted OR [95% CI] = 1.06 [0.88–1.27], p = 0.53). Results were confirmed at subgroup analysis in higher-risk subsets of patients. ConclusionIn patients undergoing non-urgent PCI, eosinophils levels are not associated with the occurrence of periprocedural myocardial infarction or myonecrosis.

Positive Association of Coronary Calcium Detected by Computed Tomography Coronary Angiography with Periprocedural Myocardial Infarction

BackgroundPeriprocedural myocardial infarction (PMI) may occur in approximately 5% to 30% of patients undergoing percutaneous coronary intervention. Whether the morphology of coronary plaque calcium affects the occurrence of PMI is unknown.Materials and MethodsA total of 616 subjects with stable angina and normal baseline cardiac troponin I levels who had undergone computed tomography angiography (CTA) were referred to elective percutaneous coronary intervention. The morphology of coronary calcium was determined by CTA analysis. PMI was defined as an elevation in 24-h post-procedural cardiac troponin I levels of > 5 times the upper limit of normal with either symptoms of myocardial ischemia, new ischemic electrocardiographic changes, or documented complications during the procedure. Logistic regression was performed to identify the effect of the morphology of coronary calcium on the occurrence of PMI.ResultsAccording to the presence or morphology of coronary calcium as shown by CTA, 210 subjects were grouped in the heavy calcification group, 258 in the mild calcification group, 40 in the spotty calcification group and 108 in the control group. The dissection rate was significantly higher in the heavy calcification group than in the control group (7.1 % vs. 1.9%, p = 0.03). The occurrence of PMI in the heavy calcification group was significantly higher than that in the control group (OR 4.38, 95% CI 1.80–10.65, p = 0.001). After multivariate adjustment, the risk of PMI still remained significantly higher in the heavy calcification group than in the control group (OR 4.04, 95% CI 1.50–10.89, p = 0.003).ConclusionsThe morphology of coronary calcium determined by CTA may help to predict the subsequent occurrence of PMI. A large amount of coronary calcium may be predictive of PMI.

Abstract 9810: Relationship Between Time of Day and Periprocedural Myocardial Infarction After Elective Angioplasty

Introduction: Recent studies have suggested an influence of circadian rhythms on myocardial infarction size and mortality among patients with ST-elevation myocardial infarction. The aim of the study is to investigate whether periprocedural myocardial infarction (PMI) is influenced by the time of day in elective patients undergoing percutaneous coronary intervention (PCI). Hypothesis: The time of day influences the occurrence of type 4A myocardial infarction in elective patients undergoing PCI. Methods: All consecutive patients undergoing elective PCI between 2007 and 2011 at our institutions with known post-interventional troponin were retrospectively included.Patients (n=1,021) were divided into 2 groups according to the starting time of the PCI: the morning group (n=651) between 07:00 and 11:59, and the afternoon group (n=370) between 12:00 and 18:59. Baseline and procedural characteristics as well as clinical outcome defined as the occurrence of PMI were compared between groups. In order to limit selection bias, all analyses were equally performed in 308 pairs using propensity score matching. Results: In the overall population, the rate of PMI was statistically lower in the morning group compared to the afternoon group (20% vs. 30%, p&lt;0.001). This difference remained statistically significant after PS-matching (21% vs. 29%, p=0.03). Multivariate analysis shows that being treated in the afternoon independently increases the risk for PMI with an odds ratio of 2.0 (95%CI: 1.1-3.4; p=0.02). Conclusions: This observational propensity score-matched study suggests that the timing of an elective PCI influences the rate of periprocedural myocardial infarction.

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