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Varying definitions for periprocedural myocardial infarction alter event rates and prognostic implications

Hanan Idris1, Sidney Lo1, Ibrahim M Shugman1

  • 1Cardiology Department, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia (H.I., S.L., I.M.S., Y.S., A.P.H., C.M., D.L., L.T., C.P.J., J.K.F.).

Journal of the American Heart Association
|November 1, 2014
PubMed
Abstract

Insights

The Society for Cardiovascular Angiography and Interventions (SCAI) definition of periprocedural myocardial infarction (PMI) identifies patients with higher rates of late death. Using the SCAI definition for PMI is crucial for accurate risk assessment.

Area of Science:

  • Cardiology
  • Biomarkers
  • Clinical Outcomes

Background:

  • Periprocedural myocardial infarction (PMI) lacks a universally consistent definition, impacting clinical interpretation.
  • Existing definitions, including the Society for Cardiovascular Angiography and Interventions (SCAI) criteria, vary in their diagnostic thresholds.

Purpose of the Study:

  • To evaluate the impact of different PMI definitions on event frequencies.
  • To determine if varying PMI definitions influence the association between PMI and late death/myocardial infarction (MI).

Main Methods:

  • Analysis of 742 patients undergoing cardiac procedures.
  • Comparison of PMI incidence using the 2007 universal definition, 2012 universal definition, and the SCAI definition.
  • Assessment of 2-year rates of death/MI based on PMI classification.

Main Results:

  • PMI incidence varied significantly by definition: 23.2% (2007), 13.3% (2012), and 2.6% (SCAI).
  • The SCAI definition identified a subset of patients with significantly higher rates of late death/MI (29.4%) compared to other definitions.
  • Side branch occlusion ≤1 mm was the most common angiographic finding in SCAI-defined PMI.

Conclusions:

  • The SCAI definition of PMI is associated with increased late death/MI rates.
  • A substantial proportion of patients meeting the 2007 universal definition did not meet the SCAI criteria, highlighting definitional discrepancies.
  • Adopting the SCAI definition may refine risk stratification for patients experiencing periprocedural myocardial infarction.
Keywords:
percutaneous coronary interventionperiprocedural myocardial infarctionreinfarctiontroponin T

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