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OCT-based fibrous cap thickness independent predictor of periprocedural MI
Fibrous cap thickness as assessed by optical coherence tomography was an important independent predictor of periprocedural MI during PCI in patients with CAD, researchers reported in a recent study.
The retrospective analysis was conducted to compare OCT, IVUS and near-infrared spectroscopy (NIRS) as methods for predicting periprocedural MI in a cohort of 110 patients undergoing PCI. Periprocedural MI was defined as postprocedural cardiac troponin I elevation greater than three times the upper limit of normal.
According to the results, 10 patients (9%) had cardiac troponin I elevation greater than three times the upper limit of normal and eight patients had an elevation greater than five times the upper limit of normal.
Compared with the rest of the cohort, patients with periprocedural MI had significantly lower minimum cap thickness assessed by OCT (55 µm vs. 90 µm), plaque burden assessed by IVUS (84% vs. 77%) and maximum 4-mm lipid core burden index by NIRS (556 vs. 339; P < .01 for all).
Fibrous cap thickness was the only factor that independently predicted cardiac troponin I elevation greater than three times the upper limit of normal (OR = 0.9; P = .02), according to results of a multivariable analysis. Cap thickness also independently predicted cardiac troponin I levels greater than five times the upper limit of normal (OR = 0.91; P = .04). When the researchers eliminated OCT data from the multivariable analysis, periprocedural MI also was predicted by plaque burden (OR = 1.13; P = .045) and maximum 4-mm lipid core burden index (OR = 1.003; P = .037). Results of a univariate analysis indicated that cap thickness by OCT predicted periprocedural MI (OR = 0.89; P < .01), as did plaque burden as assessed by IVUS (OR = 1.16; P = .01) and maximum 4-mm lipid core burden index by near infrared spectroscopy (OR = 1.004; P < .01).
“If high-risk plaques are demonstrated during imaging, more potent antiplatelet therapy (ie, prasugrel, ticagrelor, glycoprotein IIb/IIIa inhibitors) might be of value in preventing periprocedural MI,” the researchers wrote. – by Rob Volansky
Disclosure: One researcher reports founding and holding stock in InfraredX Inc., the company that produces the near-infrared catheter used in this study, and speaker fees from AstraZeneca; one researcher reports receiving research support from AstraZeneca; one researcher reports receiving research grants from GE Healthcare and Philips; and one researcher reports receiving speaking fees from Abbott, Angioscore, Boston Scientific, Cardiovascular Systems Inc. and Daiichi Sankyo/Eli Lilly.