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Impact of Plaque Composition on Cardiac Troponin Elevation After Percutaneous Coronary Intervention

An Ultrasound Analysis

Young Joon Hong, MD^_*, Gary S. Mintz, MD, Sang Wook Kim, MD^_*, Sung Yun Lee, MD^_*, Teruo Okabe, MD^_*, Augusto D. Pichard, MD^_*, Lowell F. Satler, MD^_*, Ron Waksman, MD^_*, Kenneth M. Kent, MD, PhD^_*, William O. Suddath, MD^_*, Neil J. Weissman, MD^_*,_*

^_* Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC
Cardiovascular Research Foundation, New York, New York

^_* Reprint requests and correspondence: Dr. Neil J. Weissman, 100 Irving Street, NW, Suite EB-5123, Washington, DC 20010 (Email: Neil.J.Weissman{at}medstar.net).

Objectives: We used virtual histology–intravascular ultrasound (VH-IVUS) to study the relationship between pre-percutaneous coronary intervention (PCI) coronary plaque characteristics and post-PCI cardiac troponin I (cTnI) elevation.

Background: Percutaneous coronary intervention is often complicated by post-procedural myocardial necrosis as manifested by elevated cardiac markers.

Methods: Eighty consecutive patients (29 stable and 51 unstable angina) with normal pre-PCI cTnI levels were imaged before PCI using VH-IVUS. Patients were divided into 2 groups according to the presence (Group I, n = 38) or absence (Group II, n = 42) of post-PCI cTnI elevation 3x the upper limit of normal (0.08 ng/ml).

Results: The absolute and percent necrotic core volumes were significantly greater in Group I than in Group II (13.6 ± 6.4 mm³ vs. 7.9 ± 4.4 mm³, p < 0.001, and 19.8 ± 10.4% vs. 12.8 ± 8.4%, p = 0.015, respectively). The absolute and percent necrotic core areas were significantly greater in Group I than in Group II at the minimum lumen site (1.70 ± 0.91 mm² vs. 0.61 ± 0.39 mm², p < 0.001, and 22.9 ± 11.7% vs. 10.4 ± 6.6%, p < 0.001, respectively) and at the largest necrotic core site (2.00 ± 0.86 mm² vs. 0.81 ± 0.78 mm², p < 0.001, and 24.0 ± 11.7% vs. 12.9 ± 6.6%, p < 0.001, respectively). The cTnI correlated with: 1) absolute and percent necrotic core area at the minimum lumen site and at the largest necrotic core site; 2) absolute necrotic core volume; 3) percent fibrofatty area at the minimum lumen site; and 4) lesion site plaque burden. In the multivariate analysis, absolute necrotic core area at the minimum lumen site was the only independent predictor of post-PCI cTnI elevation 3x the upper limit of normal (odds ratio: 1.318; 95% confidence interval: 1.090 to 1.594, p = 0.004).

Conclusions: The VH-IVUS analysis shows that post-PCI cTnI elevation occurs in lesions with a large necrotic core area. The VH-IVUS may play an important role in detecting which lesions are high risks for myocardial necrosis after PCI.

Key Words: coronary disease • troponin • stents • plaque • intravascular ultrasound

Abbreviations and Acronyms   CSA = cross-sectional area   cTnI = cardiac troponin I   EEM = external elastic membrane   PCI = percutaneous coronary intervention   VH-IVUS = virtual histology–intravascular ultrasound

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