Key result
Subclinical cTnI elevation at admission in elective PCI patients was associated with OCT-derived thin-cap fibroatheromas and higher rates of periprocedural myocardial injury (41% vs 18%, P=0.001).
Why the study?
Does subclinical cardiac troponin I elevation correlate with unstable plaque morphology on OCT and predict periprocedural myocardial injury in patients undergoing elective PCI?
Cohort (n=206)
Does subclinical cardiac troponin I elevation correlate with unstable plaque morphology on OCT and predict periprocedural myocardial injury in patients undergoing elective PCI?
Absolute Event Rate: 41% vs 18%
p-value: p=0.001
Subclinical troponin I elevation in stable angina patients undergoing elective PCI is associated with OCT-derived unstable plaque morphology and a higher risk of periprocedural myocardial injury.
May flag higher-risk elective PCI patients for closer monitoring; leaves open whether troponin screening or OCT alters outcomes.
BACKGROUND: The prevalence of subclinical, cardiac troponin I (cTnI) elevation in stable patients undergoing elective percutaneous coronary intervention and its relationship to culprit lesion characteristics assessed by optical coherence tomography (OCT) are unknown. METHODS AND RESULTS: We studied 206 native de novo culprit coronary lesions from 206 patients with stable angina pectoris who underwent OCT before elective percutaneous coronary intervention. Patients were divided into 2 groups according to the presence (cTnI group; n=47; 22.8%) or absence (non-cTnI group; n=159; 77.2%) of cTnI ≥0.03 ng/mL at admission. The clinical and OCT findings were compared between these 2 groups. No significant difference was found in the clinical presentation between the groups except for the serum C-reactive protein levels and presence of multivessel disease. By OCT, cTnI elevation was associated with the presence of thin-cap fibroatheromas, a greater lipid arc, and a longer lipid length. In a multivariable analysis, the presence of positive C-reactive protein levels (odds ratio, 4.38; 95% confidence interval, 1.90-10.08; P=0.001) and OCT-derived thin-cap fibroatheromas (odds ratio, 2.89; 95% confidence interval, 1.22-6.86; P=0.016) were independent predictors of cTnI elevation. Periprocedural myocardial injury, defined as postpercutaneous coronary intervention peak cTnI levels >1.0 ng/mL (5× the upper reference limit), occurred more often in patients with cTnI elevation at admission (cTnI group: 41% versus non-cTnI group: 18%; P=0.001). CONCLUSIONS: The presence of subclinical cTnI elevation at admission was not uncommon and was associated with OCT-derived unstable plaque morphology in patients undergoing elective percutaneous coronary intervention, and may help to identify patients with stable angina pectoris at high risk for periprocedural myocardial injury.
No takes yet. Share an insight, caveat, or question.
Lee et al. (2015) conducted a cohort in Stable angina pectoris (n=206). Subclinical cardiac troponin I (cTnI) elevation (≥0.03 ng/mL) vs. Absence of cTnI elevation (<0.03 ng/mL) was evaluated on Periprocedural myocardial injury (post-PCI peak cTnI >1.0 ng/mL) (p=0.001). Subclinical cTnI elevation at admission in elective PCI patients was associated with OCT-derived thin-cap fibroatheromas and higher rates of periprocedural myocardial injury (41% vs 18%, P=0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: