基于光学相干断层成像的巨噬细胞浸润对择期经皮冠状动脉介入治疗患者围手术期心肌损伤的影响

Objective Macrophages play a critical role in the development of coronary atherosclerotic plaques. Measurement of macrophage infiltration by optical coherence tomography （OCT） serves as a potential marker of coronary inflammation. However， the relationship between macrophage infiltration and periprocedural myocardial injury （PMI） following percutaneous coronary intervention （PCI） remains unclear. Methods This prospective single-center observational study consecutively enrolled patients with coronary atherosclerotic heart disease who underwent elective PCI with OCT imaging at the Sixth Medical Center of Chinese PLA General Hospital from April 2024 to January 2025. Patients were divided into PMI and non-PMI groups based on cardiac troponin （cTn） I levels within 48 hours post-PCI. Macrophage infiltration observed on OCT images was analyzed along with clinical data and other plaque characteristics OCT-derived to evaluate its predictive value for PMI. Results A total of 104 patients（116 lesions）were included，with 38 in the PMI group （42 lesions）and 66 in the non-PMI group（74 lesions）. Multivariate logistic regression analysis revealed that diabetes history，drinking history，low-density lipoprotein cholesterol（LDL-C），and interleukin-6（IL-6） were independently associated with PMI. Notably， diabetes history and drinking history were found to be protective factors against PMI（OR 0.160，95%CI 0.053-0.478，P=0.006；OR 0.151，95%CI 0.050-0.456，P=0.007）， whereas LDL-C and IL-6 were identified as risk factors（OR 2.152，95%CI 1.248-3.713， P=0.015；OR 1.245，95%CI 1.095-1.414，P＜0.001）. The results indicated that the macrophage infiltration length，mean angle， and index were all elevated in the PMI group relative to the non-PMI group. However，macrophage infiltration length and mean angle showed no statistically significant association with PMI. Integrating OCT-derived macrophage infiltration features with clinical data and other plaque characteristics obtained from OCT improves the accuracy of predicting the occurrence of PMI. Conclusions In elective PCI，OCT-derived quantitative indices of macrophage infiltration（macrophage angle and index）at the target lesion were significantly correlated with PMI. Combination of these metrics with clinical data and additional OCT plaque features yields incremental value in identifying patients at risk of PMI.