Multimodality coronary imaging to predict periprocedural myocardial necrosis after an elective percutaneous coronary intervention.

BACKGROUND: Although multiple imaging modalities have been tested to predict periprocedural myocardial necrosis (PMN), the superior predictive efficacy of these imaging findings has not been established fully. We sought to evaluate which findings of the coronary imaging tools would best provide predictive efficacy of PMN among optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography (CCT) angiography.

PATIENTS AND METHODS: A total of 130 patients with stable angina pectoris who underwent OCT, IVUS, and CCT examinations for a single de-novo preprocedural lesion were investigated. PMN was defined on the basis of two different thresholds of cardiac troponin I (cTnI) elevation: moderate PMN [five times the upper reference limit (URL)<postpercutaneous coronary intervention peak cTnI level<20 times the URL] and major PMN (peak cTnI levels>20 times the URL).

RESULTS: Moderate PMN and major PMN were observed in 25 (19.2%) and 10 (7.7%) patients, respectively. Multivariate logistic regression analysis identified four independent predictors of PMN (moderate PMN and major PMN): IVUS-defined echo-attenuated plaque (EAP), OCT-defined thin-cap fibroatheroma, OCT-defined plaque rupture, and CCT-defined low-attenuation plaque (P<0.05 for all variables). For major PMN, EAP length [odds ratio=1.80 (95% confidence interval: 1.20-2.69), P<0.01] and OCT minimum cap thickness [odds ratio=0.95 (95% confidence interval: 0.91-0.99), P<0.01] were identified as independent predictors.

CONCLUSION: IVUS-derived EAP length and OCT minimum cap thickness were significant and specific predictors of major PMN among the examined multimodality plaque features, although all three modalities independently provided imaging findings of significant predictive efficacy for PMN more than five times the URL for cTnI.