Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data

Autor: Valeria Paradies, Emanuele Barbato, Sze Y Ooi, Sebastiano Gili, Johanne Silvain, Samin K. Sharma, Claudio Cavallini, Gjin Ndrepepa, Allan S. Jaffe, Kristian Thygesen, Heerajnarain Bulluck, Derek J. Hausenloy, Julinda Mehilli, Michel Zeitouni, Gilles Montalescot, Huili L Zheng, Giuseppe Tarantini, Clemens von Birgelen, Dimitri N Feldman
Přispěvatelé: Health Technology & Services Research
Rok vydání: 2020
Předmět:
Procedural complication
medicine.medical_specialty
medicine.medical_treatment
Population
Myocardial Infarction
Infarction
UNIVERSAL DEFINITION
Coronary Artery Disease
030204 cardiovascular system & hematology
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
HIGH-SENSITIVITY TROPONIN
Clinical Research
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Angioplasty
Balloon
Coronary
ELEVATION
education
health care economics and organizations
Percutaneous Coronary Intervention/adverse effects
education.field_of_study
biology
business.industry
NECROSIS
Troponin I
Percutaneous coronary intervention
Odds ratio
Procedural myocardial injury
medicine.disease
Troponin
Confidence interval
3. Good health
Heart Injuries
Myocardial injury
Conventional PCI
biology.protein
Cardiology
Procedural myocardial infarction
Elective PCI
Cardiology and Cardiovascular Medicine
business
Biomarkers
Zdroj: Eur Heart J
Silvain, J, Zeitouni, M, Paradies, V, Zheng, H L, Ndrepepa, G, Cavallini, C, Feldman, D N, Sharma, S K, Mehilli, J, Gili, S, Barbato, E, Tarantini, G, Ooi, S Y, von Birgelen, C, Jaffe, A S, Thygesen, K, Montalescot, G, Bulluck, H & Hausenloy, D J 2021, ' Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI : a pooled analysis of patient-level data ', European Heart Journal, vol. 42, no. 4, pp. 323-334 . https://doi.org/10.1093/eurheartj/ehaa885
European heart journal, 42(4), 323-334. Oxford University Press
ISSN: 1522-9645
0195-668X
DOI: 10.1093/eurheartj/ehaa885
Popis: Aims The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated. Methods and results We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84–1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32–3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by the Fourth UDMI occurred in 12.7% of patients and was strongly associated with 1-year mortality [adj OR 3.21, 95% CI (1.42–7.27), P = 0.005]. We also present our results according to the type of troponin used (hs-cTn or conventional troponin). Conclusion Our analysis has demonstrated that in CCS patients with normal baseline cTn levels, the post-PCI cTn elevation of ≥5 × 99th percentile URL used to define Type 4a MI is associated with 1-year mortality and could be used to detect ‘major’ procedural myocardial injury in the absence of procedural complications or evidence of new myocardial ischaemia.
Databáze: OpenAIRE
Externí odkaz: