Abstract 15146: Incidence, Mechanism, Predictors, and Clinical Significance of Periprocedural Myocardial Infarction Due to Percutaneous Coronary Intervention
Background Several studies have suggested that periprocedural myocardial infarction (MI) following percutaneous coronary intervention (PCI) is associated with worse prognosis, but a definite study is not available. We therefore evaluated the incidence, mechanism, and the long-term prognostic impact of periprocedural MI in a large number of PCI patients.
Methods We analyzed individual patient-level data of studies (randomized clinical trials or registries) of patients undergoing PCI with stent implantation in which postprocedural creatine kinase-MB (CK-MB) and mortality data were collected. Periprocedural MI was defined as an elevation of the CK-MB isoenzyme at least 3 times the upper limit of normal in at least 2 blood samples within 24 hours after PCI.
Results A total of 23,002 patients from 10 studies were included. Overall incidence of periprocedural MI was 6.7%. Follow-up varied from 1 year to 5 years. During follow-up, the presence of periprocedural MI was significantly associated with long-term mortality (hazard ration [HR] 1.49, 95% confidence interval [CI] 1.20-1.86, P<0.001). Mortality was found to be a monotonically increasing function of the CK-MB ratio; ratio 3-5 with HR of 1.33, ratio 5-10 with HR of 1.63, and ratio >10 with HR of 1.84. However, a periprocedural MI was not prognostically equivalent to a spontaneous MI for long-term mortality (spontaneous MI vs. periprocedural MI; HR 3.61, 95% CI 2.64-4.94, P<0.001). The key predictors of periprocedural MI were age, gender, diabetes, acute coronary syndrome, multivessel disease, bifurcation, and stent length. Most common mechanism of periprocedural MI was a side-branch occlusion.
Conclusion Among patients who had undergone PCI with stent implantation, the frequency of periprocedural MI was not rare, and mainly related to side-branch occlusion. The presence of periprocedural MI was associated with long-term risk of mortality, but the degree of association was less than spontaneous MI.
- © 2011 by American Heart Association, Inc.