目的阐明经皮冠状动脉介入术后围手术期心肌损伤(PMI)的主要原因斑块成分:(a)红细胞来源的材料,冠状动脉粥样硬化T1加权表征(CATCH)MRI的高斑块-心肌信号强度比(PMR)表明,或(B)脂质,由近红外光谱血管内US(NIRS-IVUS)的最大4-mm脂质核心负荷指数(maxLCBI4mm)表示。材料和方法这项回顾性研究包括在两个设施进行选择性NIRS-IVUS引导的经皮冠状动脉介入治疗之前接受CATCHMRI的连续患者。PMI定义为经皮冠状动脉介入治疗后肌钙蛋白T值大于参考上限的五倍。进行多变量分析以确定PMI的预测因子。最后,MRI的预测能力,NIRS-IVUS,并对其组合进行了比较。结果103例患者共103个病灶(中位年龄,72年[IQR,64-78];78名男性患者)被包括在内。36个病灶发生PMI。在多变量分析中,PMR成为最强的预测因子(P=.001),而maxLCBI4mm不是显著的预测因子(P=.07)。当PMR被排除在分析之外时,maxLCBI4mm是唯一的独立预测因子(P=.02)。MRI和NIRS-IVUS的组合产生了最大的接受者工作曲线下面积(0.86[95%CI:0.64,0.83]),优于单独NIRS-IVUS(0.75[95%CI:0.64,0.83];P=.02)或单独MRI(0.80[95%CI:0.68,0.88];P=.30)。结论斑块内的红细胞源性物质,以CATCHMRI的高PMR为代表,与独立于血脂的PMI密切相关。MRI通过提供对斑块的独特病理见解,可能在预测PMI中起关键作用。与NIRS提供的不同。关键词:冠状动脉斑块,围手术期心肌损伤,MRI,近红外光谱血管内US补充材料可用于本文。©RSNA,2024.
Purpose To clarify the predominant causative plaque constituent for periprocedural myocardial injury (PMI) following percutaneous coronary intervention: (a) erythrocyte-derived materials, indicated by a high plaque-to-myocardium signal intensity ratio (PMR) at coronary atherosclerosis T1-weighted characterization (CATCH) MRI, or (b) lipids, represented by a high maximum 4-mm lipid core burden index (maxLCBI4 mm) at near-infrared spectroscopy intravascular US (NIRS-IVUS). Materials and Methods This retrospective study included consecutive patients who underwent CATCH
MRI before elective NIRS-IVUS-guided percutaneous coronary intervention at two facilities. PMI was defined as post-percutaneous coronary intervention troponin T values greater than five times the upper reference limit. Multivariable analysis was performed to identify predictors of PMI. Finally, the predictive capabilities of
MRI, NIRS-IVUS, and their combination were compared. Results A total of 103 lesions from 103 patients (median age, 72 years [IQR, 64-78]; 78 male patients) were included. PMI occurred in 36 lesions. In multivariable analysis, PMR emerged as the strongest predictor (P = .001), whereas maxLCBI4 mm was not a significant predictor (P = .07). When PMR was excluded from the analysis, maxLCBI4 mm emerged as the sole independent predictor (P = .02). The combination of
MRI and NIRS-IVUS yielded the largest area under the receiver operating curve (0.86 [95% CI: 0.64, 0.83]), surpassing that of NIRS-IVUS alone (0.75 [95% CI: 0.64, 0.83]; P = .02) or
MRI alone (0.80 [95% CI: 0.68, 0.88]; P = .30). Conclusion Erythrocyte-derived materials in plaques, represented by a high PMR at CATCH
MRI, were strongly associated with PMI independent of lipids. MRI may play a crucial role in predicting PMI by offering unique pathologic insights into plaques, distinct from those provided by NIRS. Keywords: Coronary Plaque, Periprocedural Myocardial Injury, MRI, Near-Infrared Spectroscopy Intravascular US Supplemental material is available for this article. © RSNA, 2024.