Impact of Coronary Plaque Composition on Cardiac Troponin Elevation After Percutaneous Coronary Intervention in Stable Angina Pectoris

Watabe, Hiroaki; Sato, Akira; Akiyama, Daiki; Kakefuda, Yuki; Adachi, Tsutomu; Ojima, Eiji; Hoshi, Tomoya; Murakoshi, Nobuyuki; Ishizu, Tomoko; Seo, Yoshihiro; Aonuma, Kazutaka

doi:10.1016/j.jacc.2012.01.051

Cited by 61 publications

(42 citation statements)

References 41 publications

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“…The mechanism underlying the increased PMI risk in left coronary dominance is still unclear. Previous studies have demonstrated that complex plaque morphologies and greater atheroma volumes bear a greater risk of significant plaque (micro)embolisation which can lead to microvascular injury [16][17][18][19][20] . Furthermore, PCI-related (stent-induced) closure of epicardial arteries may lead to blood flow reduction or occlusion in side branches with subsequent myocardial injury 16 .…”

Section: Periprocedural Myocardial Infarctionmentioning

confidence: 99%

Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial

et al. 2015

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Aims: To investigate the prognostic value of coronary dominance for various adverse clinical events following the implantation of drug-eluting stents. Methods and results:We assessed two-year follow-up data of 1,387 patients from the randomised TWENTE trial. Based on the origin of the posterior descending coronary artery, coronary circulation was categorised into left and non-left dominance (i.e., right and balanced). Target vessel-related myocardial infarction (MI) was defined according to the updated Academic Research Consortium (ARC) definition (2x upper reference limit of creatine kinase [CK], confirmed by CK-MB elevation), and periprocedural MI (PMI) as MI ≤48 hours following PCI. One hundred and thirty-six patients (9.8%) had left and 1,251 (90.2%) non-left dominance. Target lesions were more frequently located in dominant arteries (p<0.005). Left dominance was associated with more severe calcifications (p=0.006) and more bifurcation lesions (p=0.031). Non-left dominance tended to be less frequent in men (p=0.09

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Section: Periprocedural Myocardial Infarctionmentioning

confidence: 99%

Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial

et al. 2015

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“…Spotty calcification is significantly associated with vulnerable plaque, 31,32 and identified these features as predictors of PMI in SAP patients. 33 EA may result from a combination of these unstable and fragile plaque components, leading to distal embolization, and resulting in myocardial injury after PCI even in SAP patients. In contrast, not all lesions with EA may have unstable plaque…”

Section: Intra-and Interobserver Agreementmentioning

confidence: 99%

Association of Intravascular Ultrasound- and Optical Coherence Tomography-Assessed Coronary Plaque Morphology With Periprocedural Myocardial Injury in Patients With Stable Angina Pectoris

Kimura

Sugiyama

Hishikari

et al. 2015

Circ J

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“…37 We demonstrated that a CT attenuation value <55 Hounsfield units, PR (remodeling index >1.05) and spotty calcification were significant predictors of PMI; the presence of all 3 CT characteristics showed a high PPV of 94%, and their absence showed a high NPV of 90%. 38 Kodama et al demonstrated that CCTA-verified circumferential plaque calcification with LAP and PR were determinants of slowflow phenomenon during PCI. 39 Nishio et al showed that finding both LAP and PR on MDCT was highly sensitive for predicting plaque debris embolization.…”

Section: Assessment Of Coronary Vulnerable Plaquementioning

confidence: 99%

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

Sato

Aonuma

2015

Circ J

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712SATO A et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp for detecting coronary artery stenosis has been compared with ICA. Several studies have demonstrated the ability of CCTA to detect anatomically significant CAD with high negative predictive value (NPV). The CORE 64 study demonstrated that the patient-based diagnostic accuracy of quantitative CCTA for detecting stenoses ≥50% according to ICA revealed an area under the curve (AUC) of 0.93, with sensitivity of 85%, specificity of 90%, positive predictive value (PPV) of 91%, and NPV of 83%. 7 The 64-slice CCTA is accurate in identifying coronary stenoses and characterizing disease severity in symptomatic patients who have coronary artery calcium scores (CACS) <600. Given its PPV of 91% and NPV of 83%, 64-slice CCTA cannot replace conventional ICA. The substudy of CORE 64 showed that the AUC for diagnostic accuracy was similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pretest probability for CAD, and known CAD, whereas the NPV was different (0.90, 0.83, and 0.50, respectively). For excluding obstructive CAD, CCTA was less effective in patients with calcium score ≥600 and high pretest probability for obstructive CAD. 13 In the CONFIRM study, the prevalence of observed CAD with either ≥50% diameter stenosis (CAD50) or 70% diameter stenosis (CAD70) was substantially lower than predicted by guideline probabilities in the overall population (18% vs. 51% for CAD50, 10% vs.ultidetector computed tomography (MDCT) is well established for more precise evaluation of coronary stenosis relative to electron-beam CT. 1-3 Multicenter studies have confirmed the accuracy of 64-slice MDCT for directly visualizing and detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). 4-7 Furthermore, dual-source CT (DSCT), 256-slice, and 320-detector scanner were developed to significantly improve scan times, volume coverage, and spatial resolution. 8-12 With improvement in the technical aspects of coronary computed tomography angiography (CCTA), clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology, myocardial perfusion imaging (MPI), and patient outcomes. In this review, we discuss the role of cardiac MDCT beyond coronary angiography, including a comparison with other currently available imaging modalities used to examine atherosclerotic plaque and myocardial perfusion. Diagnosis of CAD Role of Cardiac Multidetector Computed Tomography Beyond Coronary AngiographyAkira Sato, MD; Kazutaka Aonuma, MD, PhDCardiac multidetector computed tomography (MDCT) has become a useful noninvasive modality for anatomical imaging of coronary artery disease (CAD). Currently, the main clinical advantage of coronary computed tomography angiography (CCTA) appears to be related to its high negative predictive value at low or intermediate pretest probability for CAD. With the development of technical aspects of MDCT, clinica...

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Impact of Coronary Plaque Composition on Cardiac Troponin Elevation After Percutaneous Coronary Intervention in Stable Angina Pectoris

Abstract: MDCT may be useful in detecting which lesions are at high risk for myocardial necrosis after PCI.

Cited by 61 publications

References 41 publications

Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial

Coronary artery dominance and the risk of adverse clinical events following percutaneous coronary intervention: insights from the prospective, randomised TWENTE trial

Association of Intravascular Ultrasound- and Optical Coherence Tomography-Assessed Coronary Plaque Morphology With Periprocedural Myocardial Injury in Patients With Stable Angina Pectoris

Role of Cardiac Multidetector Computed Tomography Beyond Coronary Angiography

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