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The Association Between Plaque Characterization by CT Angiography and Post-Procedural Myocardial Infarction in Patients With Elective Stent Implantation

Tadayuki Uetani, MD, PhD^_*,_*, Tetsuya Amano, MD, PhD^_*, Ayako Kunimura, MD^_*, Soichiro Kumagai, MD^_*, Hirohiko Ando, MD^_*, Kiminobu Yokoi, MD^_*, Tomohiro Yoshida, MD^_*, Bunichi Kato, MD, PhD^_*, Masataka Kato, MD^_*, Nobuyuki Marui, MD, PhD^_*, Michio Nanki, MD, PhD^_*, Tatsuaki Matsubara, MD, PhD, Hideki Ishii, MD, PhD, Hideo Izawa, MD, PhD, Toyoaki Murohara, MD, PhD

^_* Department of Cardiology, Chubu Rosai Hospital, Nagoya, Japan
Department of Internal Medicine Aichi-Gakuin School of Dentistry, Nagoya, Japan
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

^_* Reprint requests and correspondence: Dr. Tadayuki Uetani, Department of Cardiology, Chubu Rosai Hospital, 1-10-6, Komei, Minato-ku, Nagoya, Japan (Email: london.electricity{at}gmail.com).

Objectives: This study sought to evaluate the association between volumetric characterization of target lesions by multidetector computed tomography (MDCT) angiography and the risk of post-procedural myocardial injury after elective stent implantation.

Background: Previous reports have shown that plaque characterization of the target lesion may provide useful information for stratifying the risk of coronary stenting.

Methods: A total of 189 consecutive patients were enrolled; they underwent elective stent implantation after volumetric plaque analysis with 64-slice MDCT. Each plaque component and lumen (filled with dye) was defined as follows: 1) low-attenuation plaque (LAP) (<50 HU); 2) moderate-attenuation plaque (MAP) (50 to 150 HU); 3) lumen (151 to 500 HU); and 4) high-attenuation plaque (HAP) (>500 HU). The volume of each plaque component in the target lesion was calculated using Color Code Plaque. Post-procedural creatine kinase-MB isoform and troponin-T (TnT) at 18 h after percutaneous coronary intervention were also evaluated.

Results: The volumes of LAP (87.9 ± 94.8 mm³ vs. 47.4 ± 43.7 mm³, p < 0.01) and MAP (111.6 ± 77.5 mm³ vs. 89.8 ± 67.1 mm³, p < 0.05) were larger in patients with post-procedural myocardial injury (defined as positive TnT) than in those with negative TnT. The volumes of LAP and MAP and fraction of LAP in total plaque (LAP volume/total plaque volume) correlated with biomarkers; the MAP fraction was inversely correlated with biomarkers. The volume of LAP was an independent predictor of positive TnT after adjusting for patient background, conventional IVUS parameters, and procedural factors.

Conclusions: Post-procedural myocardial injury was associated with the volume and fraction of LAP as detected by MDCT. The volume of LAP was an independent predictor of positive TnT. Plaque analysis by MDCT would be a useful method for predicting post-procedural myocardial injury after percutaneous coronary intervention.

Key Words: coronary stent • computed tomography • coronary plaque

Abbreviations and Acronyms   CK = creatine kinase   CSA = cross-sectional area   CT = computed tomography   EEM = external elastic membrane   HAP = high-attenuation plaque   IVUS = intravascular ultrasound   LAP = low-attenuation plaque   MAP = moderate-attenuation plaque   MDCT = multidetector computed tomography   PCI = percutaneous coronary intervention   PMI = post-procedural myocardial injury/infarction   TnT = troponin-T

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