Coronary Artery Calcium Score in Predicting Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Intervention

초록

Background:This study aimed to evaluate whether coronary artery calcium score (CACS) measured with computed tomography coronary angiography (CTCA) predicts periprocedural myocardial infarction (PMI) in patients undergoing elective percutaneous coronary intervention (PCI).Methods:A total of 197 patients with stable angina underwent elective PCI after CTCA. We evaluated CACS using CTCA and assessed the clinical risk factors for PMI. PMI was defined as an elevation of troponin I levels, exceeding five times the upper limit of normal within 24 hours after PCI. Patients were followed up for major adverse cardiovascular events (MACE) for a median of 4.6 years.Results:The prevalence of PMI was 18.7% (37 patients) and patients with PMI showed a trend towards a higher CACS (721±779 vs. 498±842, P = 0.142). PMI prevalence showed a positive correlation with CACS distribution (8.0%, 1st interquartile range (IQR); 14.3%, 2nd IQR; 22.4%, 3rd IQR; 30.6%, 4th IQR; P = 0.002). The CACS cutoff value for PMI was >113 (area under the curve: 0.670; 95% confidence interval (CI): 0.600–0.736; P <0.001). Patients with CACS >113 before PCI showed a higher prevalence of PMI (26.2% vs. 5.6%, odds ratio (OR) 5.994, P <0.001). Multivariate analysis demonstrated that CACS >113 was the main predictor for PMI (OR 3.61, 95% CI: 1.145–11.363, P = 0.028). In this study, the cumulative incidence of MACE was higher in patients with PMI (54.1% vs. 10.6%, P <0.001).Conclusion:This study suggests that high CACS measured with CTCA influences PMI occurrence, which is associated with worse cardiovascular outcomes.