Association Between Periprocedural Myocardial Injury And Intra-intimal Microvessels：An Optical Coherence Tomography Study

Purpose: The relationship between neointimal characteristics of in-stent restenosis (ISR) and periprocedural myocardial injury (PMI) remains unclear. Therefore, this study aimed to investigate the relationship between PMI and ISR neointimal characteristics by using optical coherence tomography (OCT). Methods We enrolled 140 patients diagnosed with ISR with normal or stable/falling increased baseline high-sensitivity troponin T levels who underwent OCT and subsequent percutaneous coronary intervention (PCI). Patients were subdivided into with PMI (n = 53) and non-PMI (n = 87) groups based on the 4th universal definition of myocardial infarction. Results The prevalence of intra-intimal microvessels in patients with PMI was higher than in those without PMI (58.5% vs. 32.2%, P = 0.003). Multivariable logistic regression analysis showed that intra-intimal microvessels (odds ratio [OR], 3.431; 95% confidence interval [CI], 1.451–8.116, P = 0.005) were independently associated with PMI. Compared with patients without intra-intimal microvessels, those with intra-intimal microvessels had a higher prevalence of intima-calcification (52.5% vs. 32.4%, P = 0.030), lipid rich plaques (LRPs) (68.9% vs. 50.6%, P = 0.030) and peri-strut microvessels (65.6% vs. 16.4%, P < 0.001). Conclusions In patients who underwent OCT before PCI for ISR, there was a significant association between intra-intimal microvessels and occurrence of PMI. Multivariable logistic regression analysis also showed intra-intimal microvessels were independently associated with PMI.