TCT-689 Mechanisms leading to peri-procedural myocardial infarction in patients with focal versus diffuse coronary artery disease.

Abstract

Background: Periprocedural myocardial infarctions (PMI) are characterized by an elevation in cardiac biomarkers following percutaneous coronary intervention (PCI). Understanding the mechanisms underlying PMI is of clinical significance. The primary objective was to investigate the mechanism leading to PMI in patients with focal vs diffuse coronary artery disease (CAD). Method(s): This prospective study enrolled patients with at least 1 epicardial lesion with a fractional flow reserve (FFR) <= 0.80 planned to be treated by PCI. Each patient underwent manual FFR pullbacks with pullback pressure gradient (PPG). The median PPG value (0.62) was used to divide patients into predominantly focal or diffuse disease. Troponin was measured after PCI, and patients exhibiting an elevation exceeding 5 times the upper limit of normal (ULN) were subject to evaluation by an independent clinical events committee (CEC). Patients with troponin elevation >70 times xULN were adjudicated as PMI. Result(s): Overall, 855 patients were included in this analysis, with 34.5% (295 patients) exhibiting a troponin elevation exceeding 5 times the ULN. Among these cases, 66 (7.7%) were adjudicated as PMI. The prevalence of secondary criteria for PMI was as follows: electrocardiogram changes in 7.6% (5/66), new loss of viable myocardium at 0%, side branch occlusion at 18.2% (12/66), and large troponin elevation at 84.8% (56/66). Diffuse disease (PPG <0.62) was significantly associated with PMI (OR: 1.71; 95% CI: 1.03-2.88; P = 0.038). Side branch occlusion after PCI was observed in 0.7% in focal vs 2.5% in diffuse disease (P = 0.04), and large troponin elevation occurred in 4.8% in focal disease vs 8.5% in diffuse disease (P = 0.03). Additionally, PPG was significantly associated with the incidence of side branch occlusion (OR: 1.71; 95% CI: 1.03-2.88; P = 0.038) and large troponin elevation after PCI (OR: 1.83; 95% CI: 1.06-3.22; P = 0.038). Conclusion(s): The presence of diffuse atherosclerosis, as defined by PPG, was linked to an increased risk of PMI. The mechanisms leading to PMI differed between patients with focal and diffuse disease. Patients with diffuse disease demonstrated a higher incidence of branch occlusion and large troponin elevation following PCI compared with those with focal CAD. Categories: IMAGING AND PHYSIOLOGY: Physiologic Lesion Assessment.Copyright © 2024