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Published on: August 28, 2018
Prognostic Impact of Periprocedural Myocardial Infarction in Patients with Heavily Calcified Coronary Artery Disease
Jin Jung1, Sung-Ho Her1, Kyusup Lee2
1Department of Cardiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 16247 Seoul, Republic of Korea.
Insights
Periprocedural myocardial infarction (PMI) after rotational atherectomy (RA) in severe coronary artery calcification (CAC) patients increased in-hospital events. However, long-term major adverse cardiovascular and cerebrovascular events (MACCEs) showed no significant difference.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Periprocedural myocardial infarction (PMI) is more common in patients with heavily calcified lesions undergoing rotational atherectomy (RA).
- Limited data exists on the prognostic impact of PMI in patients requiring RA for severe coronary artery calcification (CAC).
Purpose of the Study:
- To determine the prognostic impact of PMI in patients who underwent percutaneous coronary intervention (PCI) using RA for severe CAC.
Main Methods:
- A total of 540 patients (583 lesions) who received PCI with RA between January 2010 and October 2019 were analyzed.
- PMI was defined as creatine kinase-myocardial band (CK-MB) elevation 10 times the upper limit of normal.
- Patients were categorized into PMI and non-PMI groups, with major adverse cardiovascular and cerebrovascular events (MACCEs) as the primary endpoint.
Main Results:
- In-hospital events were significantly more frequent in the PMI group (13.3%) compared to the non-PMI group (3.0%), p = 0.005.
- No significant difference in MACCEs was observed between the groups at 1 month (2.2% vs. 2.0%), 1-12 months (15.6% vs. 7.9%), or 12 months (17.8% vs. 9.9%).
Conclusions:
- PMI following RA in patients with severe CAC is linked to increased in-hospital events.
- A nonsignificant trend for more events during the 1-year follow-up was noted in the PMI group.
Background:
Periprocedural myocardial infarction (PMI) occurs more frequently in patients with heavily calcified lesion and undergoing rotational atherectomy (RA). However, there are limited studies addressing prognostic impact of PMI in patients requiring RA due to severe coronary artery calcification (CAC). Therefore, the objective of this study was to determine the prognostic impact of PMI in patients who underwent percutaneous coronary intervention (PCI) using RA.
Methods:
A total of 540 patients (583 lesions) who received PCI using RA were enrolled between January 2010 and October 2019. PMI was defined as elevations of creatine kinase-myocardial band (CK-MB) 10 times the upper limited normal. Patients were divided into a PMI group and a non-PMI group. Primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), a composite of cardiac death, target-vessel myocardial infarction, target-vessel revascularization, and cerebrovascular accident.
Results:
Although in-hospital events occurred more frequently in the PMI group than in the non-PMI group (15 [3.0%] vs. 6 [13.3%], p = 0.005), the incidence of MACCEs at 1 month, 1-12 months, or 12 months failed to show a significant difference between the two groups (1 month, 10 [2.0%] vs. 1 [2.2%], p 0.999; 1-12 months, 39 [7.9%] vs. 7 [15.6%], p = 0.091; 12 months, 49 [9.9%] vs. 8 [17.8%], p = 0.123).
Conclusions:
This study shows that PMI after RA in patients with severe CAC was associated with more frequent in-hospital events and a nonsignificant trend for more events during 1 year follow-up.
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