Abstract 1754: Challenges of Using Peri-procedural Myocardial Infarction as a Quality Measure Among Patients Undergoing Percutaneous Coronary Intervention
Background Peri-procedural myocardial infarction (MI) is associated with an increased risk of long-term mortality and has been suggested as a quality indicator for percutaneous coronary intervention (PCI). However, national patterns of post-procedure cardiac marker testing have not been evaluated.
Methods Data on patients undergoing elective PCI in the ACC National Cardiovascular Data Registry between 2004 and 2007 were analyzed to assess rates of post-PCI marker surveillance. The relation between intensity of marker testing and detection of peri-procedural MI (defined as marker elevation ≥3x upper limit of normal) was explored.
Results Among 215,294 patients undergoing elective PCI across 464 hospitals, 29% of patients had post-PCI cardiac marker assessment. Among hospitals, 56% measured post-PCI markers in <20% of patients while 15% of hospitals measured markers more routinely in ≥70% of patients. Hospitals that more consistently assessed markers had much higher measured rates of peri-procedural MI (8% vs. 1%). However, if the denominator of measurement was limited to tested patients, the association was reversed (Figure⇓).
Conclusions MI detection rates correlate directly with intensity of marker testing. However, in current practice, cardiac markers are infrequently assessed following routine PCI and patterns of testing vary widely across hospitals. These findings argue that the use of peri-procedural MI as a PCI quality or outcome metric could be misleading unless efforts are made to standardize marker measurement rates.