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Mortality After Procedural or Spontaneous Myocardial Infarction
Alessandro Spirito1, Samantha Sartori2, Anoop N Koshy2
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland.
Insights
Procedural myocardial infarction (pMI) and spontaneous myocardial infarction (spMI) both increase 1-year mortality, especially with troponin peaks over 35x URL. For lower troponin elevations (≤35x URL), only spMI significantly impacts mortality.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Prognostic impact of procedural myocardial infarction (pMI) versus spontaneous myocardial infarction (spMI) remains unclear.
- Understanding differential mortality risks is crucial for patient management.
Purpose of the Study:
- To compare 1-year all-cause mortality after pMI and spMI.
- To assess the impact of troponin elevation levels on mortality risk.
Main Methods:
- Retrospective analysis of 10,707 patients undergoing percutaneous coronary intervention (PCI).
- Defined pMI as post-PCI troponin increase >1x URL in chronic coronary syndrome (CCS) patients.
- Defined spMI as acute coronary syndrome with elevated troponin; assessed mortality across troponin strata.
Main Results:
- 1-year mortality was higher in pMI (7.7%) and spMI (8.5%) with troponin peaks >35x URL compared to no-MI (1.4%).
- Elevated troponin (>35x URL) after pMI or spMI significantly increased mortality risk (aHR 4.40 and 7.57, respectively).
- Only spMI showed increased mortality for troponin peaks >1-5x and >5-35x URL.
Conclusions:
- Both pMI and spMI with significant troponin elevation (>35x URL) lead to increased 1-year mortality.
- For troponin elevations up to 35x URL, spMI poses a greater mortality risk than pMI.
Background:
It remains unclear whether procedural myocardial infarction (pMI) and spontaneous myocardial infarction (spMI) have a similar impact on prognosis.
Objectives:
The aim of this study was to assess mortality after pMI and spMI.
Methods:
Patients with chronic coronary syndrome (CCS) and baseline troponin ≤1× the upper reference level (URL) or with acute spMI who underwent percutaneous coronary intervention (PCI) were included. PMI was defined as post-PCI troponin increase >1× URL in patients with CCS. SpMI comprised any acute coronary syndrome with elevated troponin. The 1-year risk of all-cause death was assessed after pMI and spMI across 3 strata of troponin elevation (>1-5×, >5-35×, and >35× URL), with CCS patients having post-PCI troponin ≤1× URL as a reference group. Conventional troponin I was measured using the Architect methodology (Abbott).
Results:
Among 10,707 patients undergoing PCI from 2012 to 2020, 8,515 patients presented with CCS and 2,192 with spMI. Among CCS patients, 913 (10.7%) had pMI. Troponin peaks >1-5×, >5-35×, and >35× URL were observed in 53%, 41%, and 6% of patients with pMI, and in 24%, 38%, and 37% of patients with spMI, respectively. Mortality at 1 year was higher after pMI (7.7%; adjusted HR: 4.40; 95% CI: 1.59-12.2), and spMI (8.5%; adjusted HR: 7.57; 95% CI: 5.44-10.5) with troponin peak >35× URL compared with no-MI (1.4%). Mortality was also increased after spMI with troponin peak >1-5× or >5-35× URL.
Conclusions:
Mortality at 1 year was significantly increased after pMI and spMI with troponin peak >35× URL, whereas for troponin levels ≤35× only spMI had a relevant impact on mortality.
