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Myocardial Infarction and Functional Outcome Assessment in Pigs
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Prognostic and Practical Validation of Current Definitions of Myocardial Infarction Associated With

Pierluigi Tricoci1, L Kristin Newby1, Robert M Clare1

  • 1Duke Clinical Research Institute, Durham, North Carolina.

JACC. Cardiovascular Interventions
|May 12, 2018
PubMed

Insights

Different definitions for periprocedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) impact 1-year mortality risk. Both the third universal definition and SCAI criteria identified higher mortality, with moderate agreement on angiographic complications.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • The definition of periprocedural myocardial infarction (MI) following percutaneous coronary intervention (PCI) lacks universal consensus.
  • Existing definitions, such as the third universal definition and Society for Cardiovascular Angiography and Interventions (SCAI) criteria, have not been fully evaluated for their prognostic implications.
  • The prevalence and impact of these definitions on patient outcomes remain unclear.

Purpose of the Study:

  • To assess the relationship between PCI-related MI, as defined by the third universal definition and SCAI criteria, and 1-year mortality.
  • To compare the agreement between angiographic core laboratory (ACL) and local investigator assessments of angiographic complications during PCI.
  • To evaluate the prognostic significance of different PCI-related MI definitions in patients with non-ST-segment elevation acute coronary syndrome.

Main Methods:

  • Analysis of 13,038 patients from the EARLY ACS and TRACER trials with non-ST-segment elevation acute coronary syndrome undergoing PCI.
  • Classification of PCI-related MI using the third universal type 4a definition and SCAI criteria.
  • Subgroup analysis (n=1,401) comparing ACL-reported versus local investigator-reported angiographic complications.

Main Results:

  • 2.0% of patients met the third universal definition of PCI-related MI, and 1.2% met SCAI criteria.
  • One-year mortality was significantly higher for patients meeting either definition: 3.3% for the third universal definition (HR: 1.96) and 5.3% for SCAI criteria (HR: 2.79).
  • Moderate agreement (κ=0.53) was observed between ACL and local investigators in detecting angiographic complications.

Conclusions:

  • Both the third universal definition and SCAI criteria for PCI-related MI are associated with increased 1-year mortality risk.
  • There is suboptimal concordance between central and local assessments of angiographic complications during PCI.
  • Standardizing MI definitions and improving complication reporting are crucial for accurate prognostic assessment in PCI patients.
Abstract

Keywords:
acute coronary syndrome(s)definitionsmyocardial infarction

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