Efficacy of Multidetector Computed Tomography to Predict Periprocedural Myocardial Injury After Percutaneous Coronary Intervention for Chronic Total Occlusion

Abstract

SummarySpecific signatures of culprit lesions detected on multidetector computed tomography (MDCT) were identified as predictors of periprocedural myocardial injury (PMI) after percutaneous coronary intervention (PCI) in patients with stable angina; PMI has been shown to be associated with a worse prognosis. We investigated the association between preprocedural culprit lesion characteristics, assessed by MDCT, and PMI after PCI for chronic total occlusion (CTO). From three medical centers, 81 patients who underwent pre-PCI MDCT and CTO PCI, and systematic cardiac troponin (cTn) sampling before and after PCI, were included. Patients were divided into two groups according to the presence or absence of post-PCI cTn elevation. Patient characteristics, MDCT findings, and procedural variables were compared between the two groups. Procedure success was observed in 65 patients (80.2%) and was not associated with PMI. The incidence of PMI was higher in patients treated with the retrograde versus the antegrade approach. On MDCT, lesion length and the presence of the napkin-ring sign were significantly associated with PMI. Multivariate analysis revealed that the lesion length (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.01-1.08; P < 0.05), napkin-ring sign (OR: 5.41; 95% CI: 1.01-29.0; P < 0.05), and retrograde approach (OR: 4.78; 95% CI: 1.28-15.4; P < 0.05) were significant predictors of PMI. PMI is not uncommon in patients undergoing elective CTO PCI, regardless of procedure success or failure. Pre-PCI MDCT may help identify patients at high risk for PMI after CTO PCI. (Int Heart J 2017; 58: 16-23) Key words: Chronic total coronary occulusion, Periprocedural myocardial necrosis, Coronary computer tomography angiography R ecent studies have reported that successful revascularization of a chronic total occlusion (CTO) may be associated with improved symptoms and clinical outcomes, such as improved all-cause mortality, lower rates of major adverse cardiac events, and reduced need for subsequent bypass surgery.1-3) However, revascularization of CTO lesions remains challenging because of its low success rate, technical complexity, time-consuming nature, and the potential for major periprocedural complications. 4) CTO percutaneous coronary intervention (PCI) complications may include coronary artery-related, cardiac non-coronary artery-related, and noncardiac complications; such as vascular access complications, systemic embolization, contrast-induced nephropathy, allergic reactions, and radiation-induced injury.5) Periprocedural myocardial injury (PMI) is a cardiac complication that has been shown to be associated with worse long-term prognosis of patients with stable angina pectoris who underwent non-CTO PCI, regardless of the success or failure of the PCI. [6][7][8] In previous studies, several patient-, lesion-, and procedure-related risk factors predicting PMI after non-CTO PCI have been reported. 6) Furthermore, specific characteristics of culprit lesions detected on multidetector computed tomography (MDCT...

Effects of Nicorandil on All-Cause Mortality and Cardiac Events in CAD Patients Receiving PCI

“…PCI and poses a challenge in the long-term management of these patients. 31,32) The ischemic preconditioning effect of nicorandil is a well-accepted mechanism for myocardial protection during PCI and leads to the prevention of heart failure in PPCI and long-term improvement of mortality and CV death. 33,34) Our meta-analysis also demonstrated the benefits of nicorandil in reducing total mortality, CV death and heart failure in patients undergoing PPCI based on the low to moderate quality of evidence of outcomes.…”

Improved Diagnosis of Detection of Late Enhancement in Left Ventricular Myocardium Using 2nd Generation 320-Slice CT Reconstructed with FIRST in Non-Ischemic Cardiomyopathy

“…Advances in CT have been dramatic and the numbers of detector rows employed have increased from 4 in 1998, to 16 in 2002, 11) 64 in 2004, 12,13) and to 320 currently. [14][15][16] In parallel, the maximum rotation speed has increased from 0.5 seconds per rotation (4 -16-slice CT) to 0.35 seconds (1st generation 320-slice CT) 14,15) and 0.275 seconds (2nd generation 320-slice CT) 16) in Toshiba Medical , and overall accuracy of detection of LE on CT against that on MRI were 65, 92, 68, 91, and 87% (Group 1), 67, 94, 73, 95, and 91% (Group 2), and 73, 97, 84, 95, and 93%, respectively (Group 3).…”

The Adaptive Remodeling of the Anterior Mitral Leaflet and Chordae Tendineae Is Associated with Mitral Valve Function in Advanced Ischemic and Nonischemic Dilated Cardiomyopathy

“…Remodeling of the MV structure in DCM patients with mild or low MR: The structure of the MV, including the subvalvular apparatus, was quantitatively analyzed on the basis of MDCT data. As a result, the length of the chordae tendineae was significantly greater in the DCM patients with mild or low MR (24 [20][21][22][23][24][25][26] mm) than that in the controls (14 [13][14][15][16] mm, P < 0.01). Furthermore, the DCM patients with mild or low MR displayed a significantly larger CC diameter and AP diameter than the controls (Table III).…”

“…The coaptation lengths in the DCM patients with mild or low MR (3.3 [2.8-3.8] mm) were significantly shorter than those in the controls (4.9 [3.9-5.6] mm, P < 0.01). Furthermore, patients in the DCM with mild or low MR group (30 [27][28][29][30][31] mm) had longer anterior mitral leaflets than the controls (22 [20][21][22][23][24] mm, P < 0.01), although the length of the posterior mitral leaflet was similar between the two groups (control: 16 [15][16][17] mm; DCM with mild or low MR: 16 [12][13][14][15][16][17][18] mm; P = 0.62). The coaptation index of the DCM patients with mild or low MR (0.79 [0.69-0.86]) was significantly higher than that of the controls (0.59 [0.55-0.67], P < 0.01), thus indicating that the coaptation site of the mitral leaflets moved in the posterior direction in the DCM patients with mild or low MR because of their longer mitral anterior leaflets.…”