Lee Tetsumin, Murai Tadashi, Isobe Mitsuaki, Kakuta Tsunekazu
Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.
Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Catheter Cardiovasc Interv. 2017 Nov 15;90(6):905-914. doi: 10.1002/ccd.27037. Epub 2017 Mar 17.
This study aimed to use optical coherence tomography (OCT) to study the relationship between plaque morphology prior to percutaneous coronary intervention (PCI) and post-PCI cardiac troponin (cTn) elevations in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Furthermore, the relationship between these findings and the adverse cardiac events during follow-up was assessed.
Association between post-PCI cTn elevations and OCT findings in NSTE-ACS patients is unclear.
We evaluated 167 patients with stable or falling cTn values after admission who underwent PCI. Periprocedural myocardial injury (PMI) was defined as an cTn increase of more than 70× upper limit of normal (ULN) in troponin-negative patients before PCI, or more than new 70× ULN elevation from the previous nadir level in pre-PCI troponin-positive patients. Clinical and OCT findings were compared between patients with (n = 48, 29%) and without (n = 119, 71%) PMI.
PMI was associated with age, prior PCI, low estimated glomerular filtration rate (eGFR), OCT-derived thin-cap fibroatheroma (TCFA), plaque rupture, and lipid length. In multivariable analysis, TCFA (odds ratio [OR], 2.88; P = 0.011), eGFR (OR, 0.97, P = 0.003), and lipid length (OR, 1.12, P = 0.020) were independent predictors of PMI. At a median follow-up of 38 months, event-free survival was significantly worse in patients with PMI (log-rank test χ = 6.47, P = 0.011).
OCT analysis showed that PMI occurs more frequently in lesions with TCFA in NSTE-ACS patients, and may identify patients having a higher risk of adverse cardiac events during follow-up. © 2017 Wiley Periodicals, Inc.
本研究旨在利用光学相干断层扫描（OCT）研究非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者经皮冠状动脉介入治疗（PCI）前斑块形态与PCI后心肌肌钙蛋白（cTn）升高之间的关系。此外，还评估了这些发现与随访期间不良心脏事件之间的关系。
NSTE-ACS患者PCI后cTn升高与OCT结果之间的关联尚不清楚。
我们评估了167例入院后cTn值稳定或下降且接受PCI的患者。围手术期心肌损伤（PMI）定义为PCI前肌钙蛋白阴性患者cTn升高超过正常上限（ULN）的70倍，或PCI前肌钙蛋白阳性患者较之前最低点水平新升高超过70倍ULN。比较了发生PMI的患者（n = 48，29%）和未发生PMI的患者（n = 119，71%）的临床和OCT结果。
PMI与年龄、既往PCI、低估算肾小球滤过率（eGFR）、OCT衍生的薄帽纤维粥样斑块（TCFA）、斑块破裂和脂质长度有关。多变量分析中，TCFA（比值比[OR]，2.88；P = 0.011）、eGFR（OR，0.97，P = 0.003）和脂质长度（OR，1.12，P = 0.020）是PMI的独立预测因素。中位随访38个月时，PMI患者的无事件生存率显著更差（对数秩检验χ = 6.47，P = 0.011）。
OCT分析显示，NSTE-ACS患者中PMI在伴有TCFA的病变中更频繁发生，并且可能识别出随访期间发生不良心脏事件风险较高的患者。©2017威利期刊公司。
