Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

Abstract

SummaryPeriprocedural myocardial infarction (PMI) is one of the major complications of percutaneous coronary intervention (PCI). We investigated the influence of coronary plaque burden and characteristics on PMI using intravascular ultrasound (IVUS) with radiofrequency-based tissue characterization technology (iMAP). The study population consisted of 33 consecutive patients with stable angina pectoris who underwent PCI. IVUS images were recorded before and after PCI for offline analysis, and coronary flow reserve (CFR) was measured after PCI. PMI was defined as a post-PCI cardiac troponin T elevation > 5 × 99 th percentile of the upper reference limit (0.014 ng/mL). Plaque volume in patients with PMI (n = 12) was significantly greater than that in patients without PMI (n = 21) (240.4 ± 106.0 mm 3 versus 152.1 ± 76.9 mm 3 , P = 0.0096). The iMAP-IVUS analysis demonstrated that the fibrotic, lipidic, and necrotic tissue volume within culprit lesions were also greater in patients with PMI than in patients without PMI (129.4 ± 52.2 mm 3 versus 94.6 ± 40.8 mm , P = 0.0071, respectively). Multivariate logistic analysis demonstrated that necrotic tissue volume was the only independent predictor of PMI. Multiple regression analysis demonstrated that the post-PCI CFR values significantly correlated with percent plaque burden, and there were no correlations with the percent tissue burden of each plaque component. In conclusion, the iMAP-IVUS analyses demonstrate that necrotic tissue volume is a potent predictor of PMI. Microcirculatory disturbance after PCI is significantly influenced by percent plaque burden, regardless of plaque compositions. (Int Heart J 2014; 55: 391-396)

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

“…23) Higuchi, et al reported that necrotic plaque volume detected by intravascular ultrasound was an independent predictor of PMI in stable angina patients. 24) Our results are in accordance with these previous reports; indeed, the napkin-ring sign is one of the specific MDCT findings that suggests plaque vulnerability and susceptibility leading to distal embolization and PMI, even after CTO PCI. Although other intracoronary imaging modalities such as intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy are capable to provide detailed information on lesion composition, MDCT may be the best available tool to acquire clear information on lesion morphology and plaque composition non-invasively before the coronary intervention, although it should be combined with patient baseline characteristics and procedural considerations.…”

Coronary plaque tissue characterization in patients with premature coronary artery disease

“…Coronary angiography is a well-established diagnostic modality for percutaneous coronary intervention (PCI) guidance, but more recent intravascular imaging techniques enhance the efficacy of lesion evaluation [10]. For example, advanced imaging has shown that the necrotic tissue volume is a potent predictor of periprocedural myocardial infarction after PCI [11]. Importantly, the incidence of an acute coronary event is determined by the extent and severity of the luminal stenosis, especially the characteristics of the plaque [12].…”

Clinical Predictors of Risk for Decreased Cardiac Tissue Perfusion After Percutaneous Coronary Intervention: A Retrospective Cohort Study

“…() argued that elderly patients tend to have more complex coronary anatomy and pathology, such as severe calcification and diffuse disease, which are unfavorable for PCI. Plaque volume in patients with PMI is significantly greater than in patients without PMI (Higuchi et al., ; Zhang et al., ).…”