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Published on: January 28, 2020
Periprocedural myocardial infarction after percutaneous coronary intervention and long-term mortality: a
Luca Paolucci1, Fabio Mangiacapra2,3, Sara Sergio2
1Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy.
Background And Aims:
Conflicting data are available regarding the association between periprocedural myocardial infarction (PMI) and mortality following percutaneous coronary intervention. The purpose of this study was to evaluate the incidence and prognostic implication of PMI according to the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition.
Methods:
Studies reporting adjusted effect estimates were systematically searched. The primary outcome was all-cause death, while cardiac death was included as a secondary outcome. Studies defining PMI according to biomarker elevation without further evidence of myocardial ischaemia ('ancillary criteria') were included and reported as 'definition-like'. Data were pooled in a random-effect model.
Results:
A total of 19 studies and 109 568 patients were included. The incidence of PMI was progressively lower across the UDMI, ARC-2, and SCAI definitions. All PMI definitions were independently associated with all-cause mortality [UDMI: hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.32-1.97; I2 34%; ARC-2: HR 2.07, 95% CI 1.40-3.08, I2 0%; SCAI: HR 3.24, 95% CI 2.36-4.44, I2 78%]. Including ancillary criteria in the PMI definitions were associated with an increased prognostic performance in the UDMI but not in the SCAI definition. Data were consistent after evaluation of major sources of heterogeneity.
Conclusions:
All currently available international definitions of PMI are associated with an increased risk of all-cause death after percutaneous coronary intervention. The magnitude of this latter association varies according to the sensitivity and prognostic relevance of each definition.
Insights
Periprocedural myocardial infarction (PMI) increases mortality after percutaneous coronary intervention, with varying risk across different definitions. Understanding these definitions is crucial for patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Conflicting data exist on periprocedural myocardial infarction (PMI) and mortality post-PCI.
- Different definitions of PMI (UDMI, ARC-2, SCAI) complicate prognostic assessment.
Purpose of the Study:
- To evaluate the incidence and prognostic implication of PMI using UDMI, ARC-2, and SCAI definitions.
- To compare the association of different PMI definitions with mortality following PCI.
Main Methods:
- Systematic search of studies reporting adjusted effect estimates for PMI.
- Meta-analysis using a random-effect model with all-cause death as primary outcome.
- Inclusion of studies defining PMI by biomarker elevation with or without ischemia ('ancillary criteria').
Main Results:
- 19 studies and 109,568 patients were included.
- PMI incidence decreased across UDMI, ARC-2, and SCAI definitions.
- All PMI definitions were independently associated with increased all-cause mortality, with varying hazard ratios.
Conclusions:
- All international PMI definitions are linked to higher all-cause death risk post-PCI.
- The strength of this association differs based on definition sensitivity and prognostic relevance.
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