Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with non‐ST segment elevation acute coronary syndrome

Objectives This study aimed to use optical coherence tomography (OCT) to study the relationship between plaque morphology prior to percutaneous coronary intervention (PCI) and post‐PCI cardiac troponin (cTn) elevations in patients with non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS). Furthermore, the relationship between these findings and the adverse cardiac events during follow‐up was assessed. Background Association between post‐PCI cTn elevations and OCT findings in NSTE‐ACS patients is unclear. Methods We evaluated 167 patients with stable or falling cTn values after admission who underwent PCI. Periprocedural myocardial injury (PMI) was defined as an cTn increase of more than 70× upper limit of normal (ULN) in troponin‐negative patients before PCI, or more than new 70× ULN elevation from the previous nadir level in pre‐PCI troponin‐positive patients. Clinical and OCT findings were compared between patients with ( n = 48, 29%) and without ( n = 119, 71%) PMI. Results PMI was associated with age, prior PCI, low estimated glomerular filtration rate (eGFR), OCT‐derived thin‐cap fibroatheroma (TCFA), plaque rupture, and lipid length. In multivariable analysis, TCFA (odds ratio [OR], 2.88; P = 0.011), eGFR (OR, 0.97, P = 0.003), and lipid length (OR, 1.12, P = 0.020) were independent predictors of PMI. At a median follow‐up of 38 months, event‐free survival was significantly worse in patients with PMI (log‐rank test χ 2 = 6.47, P = 0.011). Conclusions OCT analysis showed that PMI occurs more frequently in lesions with TCFA in NSTE‐ACS patients, and may identify patients having a higher risk of adverse cardiac events during follow‐up.