TY - JOUR
T1 - Prediction of postpercutaneous coronary intervention myocardial infarction
T2 - Insights from intravascular imaging, coronary flow, and biomarker evaluation
AU - Hoole, Stephen P.
AU - Hernández-Sánchez, Jules
AU - Brown, Adam J.
AU - Giblett, Joel P.
AU - Bennett, Martin R.
AU - West, Nick E.J.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Background Percutaneous coronary intervention-induced myocardial infarction (PMI) has prognostic significance. Identifying patients at high risk for PMI is desirable as it may alter strategy and facilitate early preventative therapy. We therefore sought to establish whether preprocedural demographic, interventional (plaque characteristics and coronary microcirculatory function), and inflammatory, endothelial damage, and platelet-derived biomarker data could predict the risk of PMI. Patients and methods We performed target vessel pressure wire to assess fractional flow reserve, index of microcirculatory resistance (IMR) and coronary flow reserve, plaque characterization by virtual histology intravascular ultrasound, and assayed peripheral biomarkers before uncomplicated PCI in 88 patients. We then analyzed post- PCI cardiac troponin level to adjudicate PMI based on the third universal definition of myocardial infarction. Results Overall incidence of PMI was 27%. Women [10/15 (66%) vs. 14/73 (19%), P<0.001] and those with low body mass (27.1 ±3.9 vs. 29.7 ± 5.5 kg/m2; P=0.02) were at significantly higher risk of PMI. Preprocedural coronary flow reserve was lower in individuals with a subsequent PMI (1.8± 1.2 vs. 2.1± 1.3. P=0.03), and patients with higher pre- PCI IMR were more likely to sustain PMI [IMR>22: 10/23 (44%) vs. =22: 14/65 (22%), P=0.04], although neither was predictive after multivariate analysis. Plaque characterization by virtual histology intravascular ultrasound did not discriminate those at risk of PMI. However, peripheral venous interleukin (IL)-18 and IL-8 levels were independently negatively and positively associated with PMI, respectively. Conclusion Women and those with low BMI, particularly when associated with high IL-8 and low IL-18 levels, appear to be at increased risk of PMI.
AB - Background Percutaneous coronary intervention-induced myocardial infarction (PMI) has prognostic significance. Identifying patients at high risk for PMI is desirable as it may alter strategy and facilitate early preventative therapy. We therefore sought to establish whether preprocedural demographic, interventional (plaque characteristics and coronary microcirculatory function), and inflammatory, endothelial damage, and platelet-derived biomarker data could predict the risk of PMI. Patients and methods We performed target vessel pressure wire to assess fractional flow reserve, index of microcirculatory resistance (IMR) and coronary flow reserve, plaque characterization by virtual histology intravascular ultrasound, and assayed peripheral biomarkers before uncomplicated PCI in 88 patients. We then analyzed post- PCI cardiac troponin level to adjudicate PMI based on the third universal definition of myocardial infarction. Results Overall incidence of PMI was 27%. Women [10/15 (66%) vs. 14/73 (19%), P<0.001] and those with low body mass (27.1 ±3.9 vs. 29.7 ± 5.5 kg/m2; P=0.02) were at significantly higher risk of PMI. Preprocedural coronary flow reserve was lower in individuals with a subsequent PMI (1.8± 1.2 vs. 2.1± 1.3. P=0.03), and patients with higher pre- PCI IMR were more likely to sustain PMI [IMR>22: 10/23 (44%) vs. =22: 14/65 (22%), P=0.04], although neither was predictive after multivariate analysis. Plaque characterization by virtual histology intravascular ultrasound did not discriminate those at risk of PMI. However, peripheral venous interleukin (IL)-18 and IL-8 levels were independently negatively and positively associated with PMI, respectively. Conclusion Women and those with low BMI, particularly when associated with high IL-8 and low IL-18 levels, appear to be at increased risk of PMI.
KW - Biomarkers
KW - Index of microcirculatory resistance
KW - Percutaneous coronary intervention-induced myocardial infarction
KW - Virtual histology intravascular ultrasound
UR - http://www.scopus.com/inward/record.url?scp=85045849614&partnerID=8YFLogxK
U2 - 10.1097/MCA.0000000000000582
DO - 10.1097/MCA.0000000000000582
M3 - Article
AN - SCOPUS:85045849614
SN - 0954-6928
VL - 29
SP - 246
EP - 253
JO - Coronary Artery Disease
JF - Coronary Artery Disease
IS - 3
ER -