Determinants of Periprocedural Myocardial Infarction in Current Elective Percutaneous Coronary Interventions

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Clinical Outcomes

Background:

• Periprocedural myocardial infarction (PMI) is linked to adverse long-term cardiovascular events.
• Understanding the determinants of PMI in elective percutaneous coronary intervention (PCI) is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the factors associated with periprocedural myocardial infarction (PMI) in patients undergoing elective percutaneous coronary intervention (PCI).

Main Methods:

• A retrospective analysis of 731 elective PCI cases, divided into PMI (n=27) and non-PMI (n=704) groups.
• Univariate and multivariate logistic regression analyses were employed to identify significant predictors of PMI.
• Key lesion characteristics including length, angle, calcification, and Medina classification were assessed.

Main Results:

• Multivariate analysis identified lesion length (OR 1.477 per 10mm), lesion angle ≥ 45° (OR 4.244), and Medina classification (0,1,1)/(1,1,1) (OR 14.843) as significant determinants of PMI.
• Complex lesions, particularly long, angulated, or true bifurcation lesions, were associated with increased risk of PMI.
• Flow limitation in side branches (TIMI grade ≤ 2) and main branches was observed in a significant proportion of PMI cases with specific lesion types.

Conclusions:

• Lesion length, lesion angle ≥ 45°, and Medina classification (0,1,1)/(1,1,1) are significant predictors of PMI in elective PCI.
• Preventing flow limitation in side branches and main vessels during PCI for complex lesions is essential to reduce PMI.
• These findings highlight the importance of careful lesion assessment and procedural strategy in diffuse, long, angulated, or true bifurcation lesions.