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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.
Journal of the American College of Cardiology
|July 24, 2024
Summary
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.
