Predictors of Periprocedural (Type IVa) Myocardial Infarction, as Assessed by Frequency-Domain Optical Coherence Tomography

Abstract

Background-Frequency-domain optical coherence tomography (FD-OCT) is easily able to define both pre-and post-stenting features of the atherosclerotic plaque that can potentially be related to periprocedural complications. We sought to examine which FD-OCT-defined characteristics, assessed both before and after stent deployment, predicted periprocedural (type IVa) myocardial infarction (MI). Methods and Results-FD-OCT was performed before and after coronary stenting in 50 patients undergoing percutaneous coronary intervention (PCI) for either non-ST segment elevation MI (NSTEMI) or stable angina. All patients underwent single-vessel stenting, and only drug-eluting stents were implanted. Troponin T was analyzed on admission, before PCI, and at 12 and 24 hours after PCI, and type IVa MI was defined in stable angina as a rise of at least 3ϫ upper reference limit and in NSTEMI as a pre-PCI troponin T fall, followed by post-PCI troponin T rise Ͼ20%.

Incidence and Clinical Significance of Poststent Optical Coherence Tomography Findings

“…[10][11][12][13][14][15][16][17]21 These studies, however, were limited to single center experiences with small sample sizes. Among these studies, the incidence of OCT-detected SED and instent dissection ranges widely: 15% to 37% for SED [9][10][11][12][13][14]16,21 and 44% to 98% for instent dissection. 9,13,14 This variability may derive from differences in the definitions used in each study.…”

“…Among these studies, the incidence of OCT-detected SED and instent dissection ranges widely: 15% to 37% for SED [9][10][11][12][13][14]16,21 and 44% to 98% for instent dissection. 9,13,14 This variability may derive from differences in the definitions used in each study. We therefore reviewed all available literature and a large number of cases before developing the definitions for poststent OCT findings used in this study.…”

“…[10][11][12][22][23][24] Thrombus was observed in 39.1% of lesions in our study, consistent with previously reported incidences ranging from 35% to 49%. [9][10][11]13,14 …”

“…Several studies have reported a high incidence of abnormal poststent OCT findings. [9][10][11][12][13][14][15][16][17] However, these studies used inconsistent OCT definitions, and most were limited to single center experiences with small sample size. Moreover, no systematic long-term follow-up was performed to investigate the clinical significance of these poststent OCT findings.…”

Association of Intravascular Ultrasound- and Optical Coherence Tomography-Assessed Coronary Plaque Morphology With Periprocedural Myocardial Injury in Patients With Stable Angina Pectoris

“…The presence of both EA and TCFA had a high predictive value for PMI, also, the frequency of PMI in the absence of those plaques might not be low, but was not contradictory to previous studies. 9, 13 We originally defined PMI as peak post-PCI cTnT >5-fold the baseline in patients with baseline cTnT ≥normal range, whereas PMI in patients with normal baseline cTnT were identified according to the "universal definition". 3 Median peak post-PCI hs-cTnT in lesions with PMI was 185ng/L, >10-fold the 99th percentile of the URL.…”