Böse Dirk, von Birgelen Clemens, Zhou Xiu Ying, Schmermund Axel, Philipp Sebastian, Sack Stefan, Konorza Thomas, Möhlenkamp Stefan, Leineweber Kirsten, Kleinbongard Petra, Wijns William, Heusch Gerd, Erbel Raimund
Dept. of Cardiology, West German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
Basic Res Cardiol. 2008 Nov;103(6):587-97. doi: 10.1007/s00395-008-0745-9. Epub 2008 Sep 11.
Cardiac marker release after percutaneous coronary interventions (PCI) reflects myocardial necrosis which is usually the result of periprocedural (micro)embolization of atherothrombotic debris and associated with impaired left ventricular function and adverse outcome.
In this prospective study, we examined 55 patients treated by direct stenting of single de-novo lesions to assess the relationship between plaque composition, as determined by preinterventional intravascular ultrasound (IVUS) with radiofrequency data (IVUS-RF) analysis (so-called Virtual Histology) versus coronary microembolization, as determined by serial measurement of cardiac markers. IVUS was performed with an electronic system and 20-MHz IVUS catheters. Serum creatine kinase (CK) and cardiac troponin I (CTnI) were determined before PCI and after 6, 12, and 24 hours.
Plaques had a volume of 99 +/- 63 mm(3) and were composed of fibrous (61 +/- 9%) and fibro-fatty tissue (27 +/- 12%), dense calcium (4 +/- 3%), and necrotic core (NC) (8 +/- 6%). NC volume per se, volume per 10 mm of segment length, and volume % were correlated (r = 0.64, 0.66, and 0.52 respectively; all P < 0.01) with the maximum increase in cardiac markers (CK 55.4 +/- 55.7 U/l; CTnI 0.49 +/- 0.68 ng/ml). Patients in the 4th quartile of NC volume (>10.8 mm(3)) had a particularly high increase in markers (P < 0.001). In contrast, total plaque volume and plaque components other than NC had no relation with cardiac markers (ns).
Patients with large NC in culprit lesions may experience more myocardial injury from peri-interventional microembolization. IVUS-RF assessment before PCI has the potential to identify lesions at particular high risk which may help to tailor PCI.
经皮冠状动脉介入治疗（PCI）后心脏标志物的释放反映心肌坏死，这通常是动脉粥样硬化血栓碎片围手术期（微）栓塞的结果，并与左心室功能受损和不良预后相关。
在这项前瞻性研究中，我们检查了55例接受单处初发病变直接支架置入术治疗的患者，以评估通过术前血管内超声（IVUS）结合射频数据（IVUS-RF）分析（所谓的虚拟组织学）确定的斑块成分与通过连续测量心脏标志物确定的冠状动脉微栓塞之间的关系。使用电子系统和20MHz的IVUS导管进行IVUS检查。在PCI前以及术后6、12和24小时测定血清肌酸激酶（CK）和心肌肌钙蛋白I（CTnI）。
斑块体积为99±63mm³，由纤维组织（61±9%）、纤维脂肪组织（27±12%）、致密钙（4±3%）和坏死核心（NC）（8±6%）组成。NC本身的体积、每10mm节段长度的体积和体积百分比与心脏标志物的最大升高相关（分别为r = 0.64、0.66和0.52；所有P < 0.01）（CK 55.4±55.7U/L；CTnI 0.49±0.68ng/ml）。NC体积处于第4四分位数（>10.8mm³）的患者标志物升高尤为明显（P < 0.001）。相比之下，总斑块体积和除NC以外的斑块成分与心脏标志物无关（无显著性差异）。
罪犯病变中存在大坏死核心的患者可能因围手术期微栓塞而遭受更多心肌损伤。PCI术前的IVUS-RF评估有可能识别出特别高危的病变，这可能有助于调整PCI方案。
