Lee Tetsumin, Murai Tadashi, Yonetsu Taishi, Suzuki Asami, Hishikari Keiichi, Kanaji Yoshihisa, Matsuda Junji, Araki Makoto, Niida Takayuki, Isobe Mitsuaki, Kakuta Tsunekazu
From the Department of Cardiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan (T.L., T.M., T.Y., A.S., K.H., Y.K., J.M., M.A., T.N., T.K.); and Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan (M.I.).
Circ Cardiovasc Interv. 2015 Apr;8(4). doi: 10.1161/CIRCINTERVENTIONS.114.001727.
The prevalence of subclinical, cardiac troponin I (cTnI) elevation in stable patients undergoing elective percutaneous coronary intervention and its relationship to culprit lesion characteristics assessed by optical coherence tomography (OCT) are unknown.
We studied 206 native de novo culprit coronary lesions from 206 patients with stable angina pectoris who underwent OCT before elective percutaneous coronary intervention. Patients were divided into 2 groups according to the presence (cTnI group; n=47; 22.8%) or absence (non-cTnI group; n=159; 77.2%) of cTnI ≥0.03 ng/mL at admission. The clinical and OCT findings were compared between these 2 groups. No significant difference was found in the clinical presentation between the groups except for the serum C-reactive protein levels and presence of multivessel disease. By OCT, cTnI elevation was associated with the presence of thin-cap fibroatheromas, a greater lipid arc, and a longer lipid length. In a multivariable analysis, the presence of positive C-reactive protein levels (odds ratio, 4.38; 95% confidence interval, 1.90-10.08; P=0.001) and OCT-derived thin-cap fibroatheromas (odds ratio, 2.89; 95% confidence interval, 1.22-6.86; P=0.016) were independent predictors of cTnI elevation. Periprocedural myocardial injury, defined as postpercutaneous coronary intervention peak cTnI levels >1.0 ng/mL (5× the upper reference limit), occurred more often in patients with cTnI elevation at admission (cTnI group: 41% versus non-cTnI group: 18%; P=0.001).
The presence of subclinical cTnI elevation at admission was not uncommon and was associated with OCT-derived unstable plaque morphology in patients undergoing elective percutaneous coronary intervention, and may help to identify patients with stable angina pectoris at high risk for periprocedural myocardial injury.
在接受择期经皮冠状动脉介入治疗的稳定患者中，亚临床心肌肌钙蛋白I（cTnI）升高的发生率及其与光学相干断层扫描（OCT）评估的罪犯病变特征之间的关系尚不清楚。
我们研究了206例稳定型心绞痛患者的206处原发性新发罪犯冠状动脉病变，这些患者在择期经皮冠状动脉介入治疗前接受了OCT检查。根据入院时cTnI≥0.03 ng/mL的情况将患者分为两组：存在cTnI升高的患者为cTnI组（n = 47；22.8%），不存在cTnI升高的患者为非cTnI组（n = 159；77.2%）。比较两组的临床和OCT检查结果。除血清C反应蛋白水平和多支血管病变情况外，两组间临床表现无显著差异。通过OCT检查发现，cTnI升高与薄帽纤维粥样斑块的存在、更大的脂质弧和更长的脂质长度有关。在多变量分析中，C反应蛋白水平阳性（比值比，4.38；95%置信区间，1.90 - 10.08；P = 0.001）和OCT衍生的薄帽纤维粥样斑块（比值比，2.89；95%置信区间，1.22 - 6.86；P = 0.016）是cTnI升高的独立预测因素。围手术期心肌损伤定义为经皮冠状动脉介入治疗后cTnI峰值水平>1.0 ng/mL（高于参考上限5倍），在入院时cTnI升高的患者中更常见（cTnI组：41% 对非cTnI组：18%；P = 0.001）。
入院时存在亚临床cTnI升高并不少见，且与接受择期经皮冠状动脉介入治疗患者的OCT衍生不稳定斑块形态有关，可能有助于识别有围手术期心肌损伤高风险的稳定型心绞痛患者。
