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Periprocedural myocardial infarction in patients undergoing complex versus noncomplex percutaneous coronary

Raffaele Piccolo1, Attilio Leone1, Fiorenzo Simonetti1

  • 1Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 20, 2023
PubMed
Abstract

Insights

Complex percutaneous coronary intervention (PCI) significantly increases the risk of periprocedural myocardial infarction (MI) compared to noncomplex PCI. Careful procedural planning is crucial for managing this elevated risk in patients with chronic coronary syndrome.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • Limited data exist on periprocedural myocardial infarction (MI) risk in complex versus noncomplex percutaneous coronary intervention (PCI).
  • Assessing this risk is crucial for patient safety and procedural planning.

Purpose of the Study:

  • To evaluate the risk of periprocedural MI in patients undergoing complex versus noncomplex elective PCI.
  • To compare MI rates using multiple diagnostic criteria, including the fourth Universal Definition of Myocardial Infarction (UDMI).

Main Methods:

  • Prospective, single-center registry study.
  • Inclusion of 1010 patients with chronic coronary syndrome undergoing elective PCI between 2017 and 2021.
  • Definition of complex PCI based on multiple criteria (e.g., ≥3 vessels treated, ≥3 stents implanted, chronic total occlusion treatment).

Main Results:

  • Complex PCI was performed in 22.4% of patients (226/1010).
  • Periprocedural MI rates were significantly higher in complex PCI patients across multiple definitions (e.g., 26.5% vs. 14.5% by fourth UDMI; p < 0.001).
  • Complex PCI independently predicted fourth UDMI periprocedural MI (OR 1.54, 95% CI: 1.04-2.27, p=0.031).

Conclusions:

  • Complex PCI is associated with a significantly higher risk of periprocedural MI in elective PCI patients.
  • These findings underscore the need to consider upfront the elevated risk associated with complex PCI procedures.
  • Risk stratification and careful planning are essential for patients undergoing complex PCI.
Keywords:
complex PCIcoronary artery diseasepercutaneous coronary interventionperiprocedural myocardial infarction

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