Clinical and Imaging Predictors of Impaired Myocardial Perfusion in Symptomatic Patients After Percutaneous Coronary Intervention: Insights from Dynamic CT Myocardial Perfusion Imaging

Overview

Journal Quant Imaging Med Surg

Specialty Radiology

Date 2021 Jul 12

PMID 34249657

Citations 5

Authors

Haiyan Ma

Xu Dai

Xiaojun Yang

Xihui Zhao

Rongpin Wang

Jiayin Zhang

Affiliations

Soon will be listed here.

Abstract

Background: We aimed to investigate the relationship between baseline clinical characteristics and postprocedural myocardial perfusion as determined by dynamic computed tomography myocardial perfusion imaging (CT-MPI).

Methods: We retrospectively included consecutive symptomatic post percutaneous coronary intervention (PCI) patients, who underwent dynamic CT-MPI + coronary CT angiography (CCTA) and who were revealed to have patent stents on previously revascularized lesions. Myocardial blood flow (MBF) was measured for stented territories and reference territories. Various baseline clinical and angiographic parameters were tested for the association with reduced MBF of stented territories.

Results: A total of 81 patients with 96 stented vessels were included in the analysis. The mean effective doses of radiation for the whole integrated CT protocol (calcium score + dynamic CT-MPI + CCTA) was 4.89±1.14 (2.58-6.93) mSv. Overall, 49 stented vessels had reduced MBF (75.3±17.2 mL/100 mL/min) within related territories, whereas 47 stented vessels had normal MBF (138.6±20.5 mL/100 mL/min). Peak levels of high-sensitivity cardiac troponin I (hs-cTnI), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and glucose were significantly higher, while preprocedural thrombolysis in myocardial infarction (TIMI) flow grade was lower in participants with reduced MBF of stented territories. Acute myocardial infarction (AMI) also predominantly presented in participants with decreased MBF after revascularization. According to multivariate analysis, peak hs-cTnI level was the strongest predictor [adjusted hazard ratio (HR): 4.548, P=0.003] for decreased myocardial perfusion, followed by TIMI flow grade, AMI, stenotic extent, and NT-pro-BNP.

Conclusions: The baseline hs-cTnI peak level was the strongest predictor for decreased myocardial perfusion after revascularization, followed by AMI, stenotic extent, and NT-pro-BNP.

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References

Li Y, Yuan M, Yu M, Lu Z, Shen C, Wang Y . Prevalence of Decreased Myocardial Blood Flow in Symptomatic Patients with Patent Coronary Stents: Insights from Low-Dose Dynamic CT Myocardial Perfusion Imaging. Korean J Radiol. 2019; 20(4):621-630. PMC: 6424835. DOI: 10.3348/kjr.2018.0399. View

Chia S, Senatore F, Raffel O, Lee H, Wackers F, Jang I . Utility of cardiac biomarkers in predicting infarct size, left ventricular function, and clinical outcome after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2009; 1(4):415-23. DOI: 10.1016/j.jcin.2008.04.010. View

Li Y, Yu M, Dai X, Lu Z, Shen C, Wang Y . Detection of Hemodynamically Significant Coronary Stenosis: CT Myocardial Perfusion versus Machine Learning CT Fractional Flow Reserve. Radiology. 2019; 293(2):305-314. DOI: 10.1148/radiol.2019190098. View

Sousa J, Serruys P, Costa M . New frontiers in cardiology: drug-eluting stents: Part II. Circulation. 2003; 107(18):2383-9. DOI: 10.1161/01.CIR.0000069331.67148.2F. View

Pan J, Yuan M, Yu M, Gao Y, Shen C, Wang Y . Myocardial Blood Flow Quantified by Low-Dose Dynamic CT Myocardial Perfusion Imaging Is Associated with Peak Troponin Level and Impaired Left Ventricle Function in Patients with ST-Elevated Myocardial Infarction. Korean J Radiol. 2019; 20(5):709-718. PMC: 6470086. DOI: 10.3348/kjr.2018.0729. View

Li Y, Yu M, Li W, Lu Z, Wei M, Zhang J . Third generation dual-source CT enables accurate diagnosis of coronary restenosis in all size stents with low radiation dose and preserved image quality. Eur Radiol. 2018; 28(6):2647-2654. DOI: 10.1007/s00330-017-5256-3. View

Alessio A, Bindschadler M, Busey J, Shuman W, Caldwell J, Branch K . Accuracy of Myocardial Blood Flow Estimation From Dynamic Contrast-Enhanced Cardiac CT Compared With PET. Circ Cardiovasc Imaging. 2019; 12(6):e008323. PMC: 6579038. DOI: 10.1161/CIRCIMAGING.118.008323. View

Schumacher S, Stuijfzand W, Driessen R, van Diemen P, Bom M, Everaars H . Impact of Specific Crossing Techniques in Chronic Total Occlusion Percutaneous Coronary Intervention on Recovery of Absolute Myocardial Perfusion. Circ Cardiovasc Interv. 2019; 12(11):e008064. DOI: 10.1161/CIRCINTERVENTIONS.119.008064. View

Jaffe R, Dick A, Strauss B . Prevention and treatment of microvascular obstruction-related myocardial injury and coronary no-reflow following percutaneous coronary intervention: a systematic approach. JACC Cardiovasc Interv. 2010; 3(7):695-704. DOI: 10.1016/j.jcin.2010.05.004. View

10.

Cerqueira M, Weissman N, Dilsizian V, Jacobs A, Kaul S, Laskey W . Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002; 105(4):539-42. DOI: 10.1161/hc0402.102975. View

11.

Rossi A, Merkus D, Klotz E, Mollet N, de Feyter P, Krestin G . Stress myocardial perfusion: imaging with multidetector CT. Radiology. 2013; 270(1):25-46. DOI: 10.1148/radiol.13112739. View

12.

Hickethier T, Wenning J, Bratke G, Maintz D, Michels G, Bunck A . Evaluation of soft-plaque stenoses in coronary artery stents using conventional and monoenergetic images: first experience and comparison of two different dual-energy techniques. Quant Imaging Med Surg. 2020; 10(3):612-623. PMC: 7136730. DOI: 10.21037/qims.2020.02.11. View

13.

Yu M, Chen X, Dai X, Pan J, Wang Y, Lu B . The Value of Low-Dose Dynamic Myocardial Perfusion CT for Accurate Evaluation of Microvascular Obstruction in Patients With Acute Myocardial Infarction. AJR Am J Roentgenol. 2019; 213(4):798-806. DOI: 10.2214/AJR.19.21305. View

14.

Bamberg F, Klotz E, Flohr T, Becker A, Becker C, Schmidt B . Dynamic myocardial stress perfusion imaging using fast dual-source CT with alternating table positions: initial experience. Eur Radiol. 2010; 20(5):1168-73. DOI: 10.1007/s00330-010-1715-9. View

15.

Yuan M, Wu H, Li R, Yu M, Dai X, Zhang J . The value of quantified plaque analysis by dual-source coronary CT angiography to detect vulnerable plaques: a comparison study with intravascular ultrasound. Quant Imaging Med Surg. 2020; 10(3):668-677. PMC: 7136737. DOI: 10.21037/qims.2020.01.13. View

16.

Hachamovitch R, Rozanski A, Shaw L, Stone G, Thomson L, Friedman J . Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy. Eur Heart J. 2011; 32(8):1012-24. DOI: 10.1093/eurheartj/ehq500. View

17.

Sousa J, Serruys P, Costa M . New frontiers in cardiology: drug-eluting stents: Part I. Circulation. 2003; 107(17):2274-9. DOI: 10.1161/01.CIR.0000069330.41022.90. View

18.

Yu M, Shen C, Dai X, Lu Z, Wang Y, Lu B . Clinical Outcomes of Dynamic Computed Tomography Myocardial Perfusion Imaging Combined With Coronary Computed Tomography Angiography Versus Coronary Computed Tomography Angiography-Guided Strategy. Circ Cardiovasc Imaging. 2020; 13(1):e009775. DOI: 10.1161/CIRCIMAGING.119.009775. View

19.

Hassan A, Bergheanu S, Hasan-Ali H, Liem S, van der Laarse A, Wolterbeek R . Usefulness of peak troponin-T to predict infarct size and long-term outcome in patients with first acute myocardial infarction after primary percutaneous coronary intervention. Am J Cardiol. 2009; 103(6):779-84. DOI: 10.1016/j.amjcard.2008.11.031. View

20.

Balian V, Galli M, Marcassa C, Cecchin G, Child M, Barlocco F . Intracoronary ST-segment shift soon after elective percutaneous coronary intervention accurately predicts periprocedural myocardial injury. Circulation. 2006; 114(18):1948-54. DOI: 10.1161/CIRCULATIONAHA.106.620476. View