Abstract 20415: Incidence of Post-Procedural Myocardial Infarction and Risk of Recurrent Cardiac Events After Coronary Stenting
Introduction: The impact of post-procedural myocardial infarction (PPMI) after percutaneous coronary intervention (PCI) on clinical outcomes in the era of novel P2Y12 therapies is unclear.
Hypothesis: Novel antiplatelet agents may decrease the risk of adverse outcomes in PPMI patients.
Methods: We retrospectively analyzed consecutive patients from a large tertiary center database for the incidence of PPMI and clinical outcomes from 2008-2014. PPMI was defined using the third universal definition of MI. We evaluated 1-year death, MI, target vessel revascularization and MACE (composite of death or MI) between the groups. Multivariable adjustment methods were used to calculate adjusted risks.
Results: During the study period, 15266 patients underwent PCI, among these 1460 (9.6%) had PPMI. Patients with PPMI were older with a higher prevalence of female sex, diabetes, renal dysfunction and lower left ventricular ejection fraction compared to their counterparts without PPMI. Use of potent P2Y12 inhibitors was 19.6 vs. 11.2% in the PPMI vs. non-PPMI groups (p <0.01). At 1-year, PPMI patients had greater incidence of all clinical outcomes (see Figure). In clopidogrel treated patients the adjusted risk for MACE was significantly higher in PPMI vs. non-PPMI groups (HR 1.43, 95% CI 1.12-1.82). Comparatively in patients treated with potent P2Y12 receptor inhibitors, a differential risk for MACE was not observed in PPMI vs. non-PPMI patients (HR 0.96, 95% CI 0.39-2.36, p-interaction 0.15).
Conclusions: Patients with PPMI are a higher risk group who experience worse 1-year outcomes. While PPMI patients are more likely to be prescribed more potent P2Y12 receptor inhibitors, the benefits of these novel agents are not accentuated in such patients.
Author Disclosures: J. Chandrasekhar: None. U. Baber: None. M. Aquino: None. S. Sartori: None. P. Vijay: None. S. Shah: None. M. Faggioni: None. B. Vogel: None. S. Farhan: None. G. Giustino: None. P. Moreno: None. P. Krishnan: None. G. Dangas: None. J. Kovacic: None. R. Mehran: None. S. Sharma: None. A. Kini: None.
- © 2016 by American Heart Association, Inc.