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Frequency and Outcomes of Periprocedural MI in Patients With Chronic Coronary Syndromes Undergoing PCI

Yasushi Ueki1, Tatsuhiko Otsuka1, Sarah Bär1

  • 1Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Journal of the American College of Cardiology
|February 11, 2022
PubMed
Abstract

Insights

Different definitions for periprocedural myocardial infarction (MI) impact patient outcomes. The Academic Research Consortium-2 (ARC-2) and Society for Cardiovascular Angiography and Interventions (SCAI) criteria are more prognostic for cardiac death than older Universal Definition of Myocardial Infarction (UDMI) criteria.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomarker Research

Background:

  • Definitions for periprocedural myocardial infarction (MI) vary in biomarker thresholds and ischemia criteria, lacking robust validation.
  • This variability complicates accurate assessment of MI frequency and its clinical impact.

Purpose of the Study:

  • To evaluate the incidence and prognostic significance of periprocedural MI using different definitions in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI).

Main Methods:

  • Utilized data from the Bern PCI registry (2010-2018) for 4,404 patients with CCS undergoing PCI.
  • Assessed periprocedural MI using the third and fourth Universal Definition of Myocardial Infarction (UDMI), Academic Research Consortium-2 (ARC-2), and Society for Cardiovascular Angiography and Interventions (SCAI) criteria.
  • Primary endpoint was 1-year cardiac death.

Main Results:

  • Periprocedural MI rates varied: 18.0% (3rd UDMI), 14.9% (4th UDMI), 2.0% (ARC-2), and 2.0% (SCAI).
  • One-year cardiac mortality was 2.9% (3rd UDMI), 3.0% (4th UDMI), 5.8% (ARC-2), and 10.0% (SCAI).
  • ARC-2 and SCAI criteria demonstrated greater prognostic relevance for 1-year cardiac death compared to UDMI criteria.

Conclusions:

  • ARC-2 and SCAI criteria identified periprocedural MI less frequently (7-9 times) than UDMI criteria in CCS patients undergoing PCI.
  • Periprocedural MI identified by ARC-2 and SCAI criteria showed stronger prognostic value for 1-year cardiac death.
  • The findings highlight the importance of using validated, contemporary MI definitions for accurate risk stratification.
Keywords:
chronic coronary syndromecoronary artery diseasemyocardial infarctionpercutaneous coronary intervention

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