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Impact of Periprocedural Myocardial Injury on Long-Term Outcomes After Percutaneous Coronary Intervention Requiring
Hiroki Emori1, Yasutsugu Shiono2, Nehiro Kuriyama1
1Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan.
The American Journal of Cardiology
|April 27, 2024
Summary
Cardiac troponin elevation, or periprocedural myocardial injury (PMI), is common after percutaneous coronary intervention (PCI) with atherectomy. Significant PMI increases the risk of target lesion failure and cardiovascular death in patients with calcified lesions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- Cardiac troponin elevation after percutaneous coronary intervention (PCI) with atherectomy lacks established prognostic implications.
- Severely calcified lesions present unique challenges during PCI.
Purpose of the Study:
- To investigate the incidence of periprocedural myocardial injury (PMI) following PCI with atherectomy.
- To assess the association between PMI and cardiovascular events in patients with severely calcified lesions.
Main Methods:
- Analysis of 346 patients (377 lesions) undergoing PCI with atherectomy (Jan 2018-Dec 2021).
- Measurement of peak post-PCI high-sensitivity cardiac troponin (hs-cTn).
- Lesion-based analysis of target lesion failure (TLF) up to 5 years post-PCI.
Main Results:
- 362 lesions (96%) showed hs-cTn increase; 83 lesions (22%) had significant PMI (hs-cTn ≥70 × upper reference limit).
- Significant PMI was linked to a higher risk of TLF (aHR 1.93; 95% CI 1.12-3.30).
- Increased cardiovascular death risk was a primary driver of TLF in significant PMI (aHR 5.29; 95% CI 1.46-19.16).
Conclusions:
- Elevated hs-cTn is frequent after PCI with atherectomy.
- Significant PMI is an independent predictor of adverse outcomes, including TLF and cardiovascular death.
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