Coronary CT angiography-derived plaque characteristics and physiologic patterns for peri-procedural myocardial infarction and subsequent events

医学 狼牙棒 心脏病学 传统PCI 内科学 心肌梗塞 经皮冠状动脉介入治疗 部分流量储备 冠状动脉疾病 置信区间 优势比 放射科 冠状动脉造影
作者
Neng Dai,Zhangwei Chen,Fan Zhou,You Zhou,Nan Hu,Shaofeng Duan,Wei Wang,Long Jiang Zhang,Juying Qian,Junbo Ge
出处
期刊:European Journal of Echocardiography [Oxford University Press]
卷期号:24 (7): 897-908 被引量:4
标识
DOI:10.1093/ehjci/jead025
摘要

Abstract Aims Peri-procedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) has been shown to be associated with worse clinical outcomes. We aimed to investigate the value of coronary plaque characteristics and physiologic disease patterns (focal vs. diffuse) assessed by coronary computed tomography angiography (CTA) in predicting PMI and adverse events. Methods and results Three hundred fifty-nine patients with normal pre-PCI high-sensitivity cardiac troponin T (hs-cTnT) underwent CTA before PCI were analysed. The high-risk plaque characteristics (HRPC) were assessed on CTA. The physiologic disease pattern was characterized using CTA fractional flow reserve-derived pullback pressure gradients (FFRCT PPG). PMI was defined as an increase in hs-cTnT to >5 times the upper limit of normal after PCI. The major adverse cardiovascular events (MACE) were a composite of cardiac death, spontaneous myocardial infarction, and target vessel revascularization. The presence of ≥3 HRPC in the target lesions [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.29–3.80, P = 0.004] and low FFRCT PPG (OR 1.23, 95% CI 1.02–1.52, P = 0.028) were independent predictors of PMI. In a four-group classification according to HRPC and FFRCT PPG, patients with ≥3 HRPC and low FFRCT PPG had the highest risk of MACE (19.3%; overall P = 0.001). Moreover, the presence of ≥3 HRPC and low FFRCT PPG was an independent predictor of MACE and showed incremental prognostic value compared with a model with clinical risk factors alone [C index = 0.78 vs. 0.60, P = 0.005, net reclassification index = 0.21 (95% CI: 0.04–0.48), P = 0.020]. Conclusions Coronary CTA can evaluate plaque characteristics and physiologic disease patterns simultaneously, which plays an important role for risk stratification before PCI.
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