Author + information
- Received December 17, 2014
- Revision received February 24, 2015
- Accepted March 21, 2015
- Published online June 1, 2015.
- Annapoorna S. Kini, MD∗ (, )
- Sadako Motoyama, MD, PhD,
- Yuliya Vengrenyuk, PhD,
- Jonathan E. Feig, MD, PhD,
- Jacobo Pena, MD,
- Usman Baber, MD,
- Arjun M. Bhat, MD,
- Pedro Moreno, MD,
- Jason C. Kovacic, MD, PhD,
- Jagat Narula, MD, PhD and
- Samin K. Sharma, MD
- Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Annapoorna S. Kini, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Objectives The aim of this study is to compare the relative merits of optical coherence tomography (OCT), intravascular ultrasound (IVUS), and near infrared spectroscopy (NIRS) in patients with coronary artery disease for the prediction of periprocedural myocardial infarction (MI).
Background Although several individual intravascular imaging modalities have been employed to predict periprocedural MI, it is unclear which of the imaging tools would best allow prediction of this complication.
Methods We retrospectively analyzed 110 patients who underwent OCT, IVUS, and NIRS. Periprocedural MI was defined as a post-procedural cardiac troponin I (cTnI) elevation above 3× the upper limit of normal; analysis was also performed for cTnI ≥5× the upper limit of normal.
Results cTnI ≥3× was observed in 10 patients (9%) and 8 patients had cTnI ≥5×. By OCT, minimum cap thickness was significantly lower (55 vs. 90 μm, p < 0.01), and the plaque burden by IVUS (84 ± 9% vs. 77 ± 8%, p < 0.01) and maximum 4-mm lipid core burden index by NIRS (556 vs. 339, p < 0.01) were greater in the cTnI ≥3× group. Multivariate logistic regression analysis identified cap thickness as the only independent predictor for cTnI ≥3× the upper limit of normal (odds ratio [OR]: 0.90, p = 0.02) or cTnI ≥5× (OR: 0.91, p = 0.04). If OCT findings were excluded from the analysis, plaque burden (OR: 1.13, p = 0.045) and maximum 4-mm lipid core burden index (OR: 1.003, p = 0.037) emerged to be the independent predictors.
Conclusions OCT-based fibrous cap thickness is the most important predictor of periprocedural MI. In the absence of information about cap thickness, NIRS lipid core or IVUS plaque burden best determined the likelihood of the periprocedural event.
- coronary artery disease
- percutaneous coronary intervention
- periprocedural myocardial infarction
- fibrous cap thickness
- intravascular imaging
Dr. Moreno is a founder and stockholder of Infraredx, Inc., the company that produces the near-infrared catheter used in this study; and has received speaker fees from AstraZeneca. Dr. Kovacic has received research support form AstraZeneca. Dr. Narula has received research grants from Philips and GE Healthcare. Dr. Sharma has received speaking fees from Abbott, Angioscore, Boston Scientific, Cardiovascular Systems Inc., and Daiichi Sankyo/Lilly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 17, 2014.
- Revision received February 24, 2015.
- Accepted March 21, 2015.
- American College of Cardiology Foundation