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Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary
Konstantinos C Koskinas1, Gjin Ndrepepa2, Lorenz Räber1
1From the Department of Cardiology, Bern University Hospital, Switzerland (K.C.K., L.R., T.Z., L.H., S.W.).
Insights
The Society for Cardiovascular Angiography and Interventions (SCAI) definition for periprocedural myocardial infarction (PMI) is specific but not sensitive for predicting mortality after percutaneous coronary interventions. A lower hs-cTnT threshold of 10× URL offers better prognostic prediction.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Prognostic significance of myocardial injury after percutaneous coronary interventions (PCI) is not well-defined.
- Society for Cardiovascular Angiography and Interventions (SCAI) proposed thresholds for periprocedural myocardial infarction (PMI).
- Validation of SCAI thresholds with high-sensitivity cardiac troponins (hs-cTnT) is needed.
Purpose of the Study:
- Assess prognostic impact of SCAI-defined PMI.
- Explore optimal prognostic thresholds of hs-cTnT after elective PCI.
Main Methods:
- Evaluated 8140 patients undergoing elective PCI with serial hs-cTnT measurements.
- Defined PMI based on SCAI criteria and hs-cTnT levels.
- Assessed 1-year all-cause mortality as primary outcome.
Main Results:
- SCAI-defined PMI (1.7% of patients) was associated with higher 1-year mortality (12.9% vs 2.5%).
- Optimal hs-cTnT threshold for prognosis was >10× URL, identified in 14.6% of patients.
- Lower hs-cTnT threshold showed better sensitivity and overall performance than SCAI definition.
Conclusions:
- SCAI-defined PMI is an independent, specific, but insensitive predictor of 1-year mortality.
- A lower hs-cTnT threshold (10× URL) provides an optimal balance of sensitivity and specificity for predicting mortality post-PCI.
Background:
The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions.
Methods And Results:
We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT >70× upper reference limit (URL) in patients with nonelevated (≤1× URL) baseline levels; or incremental increase >70× URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n=140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51-6.68; P<0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50-7.11; P<0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was >10×URL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin.
Conclusions:
In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10× URL) in this cohort.
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