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Updated: Jul 7, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Effect of Periprocedural Myocardial Infarction After Initial Revascularization With Left Main PCI in Patients With
Hao-Yu Wang1,2,3,4, Bo Xu1,4,5, Kefei Dou1,2,3,4
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Background:
Periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) for left main coronary artery disease (LMCAD) may be particularly deleterious in patients with recent myocardial infarction (MI). We sought to determine the rates and prognostic relevance of PMI using different definitions and biomarker thresholds after PCI for LMCAD in patients with recent MI.
Methods:
Between January 2004 and December 2016, 442 patients underwent PCI for LMCAD at a median of 3 days after presentation with MI. A total of 350 patients presented with elevated cardiac biomarker levels (349 with serial creatine kinase-myocardial band [CK-MB] and 219 with serial cardiac troponin I (cTnI) values) that were stable or falling before the PCI. In this cohort, PMI within 48 hours of PCI was adjudicated using Society for Cardiovascular Angiography & Interventions (SCAI), Academic Research Consortium 2 (ARC-2), and fourth Universal Definition of Myocardial Infarction (UDMI) criteria. The primary and secondary end points were 3-year rates of cardiovascular (CV) and all-cause death.
Results:
An incremental post-PCI rise in CK-MB starting at ≥10× the upper reference limit from baseline was significantly associated with 3-year CV death (adjusted hazard ratio [aHR], 7.96; 95% confidence interval [CI], 2.89-21.90), whereas CV death was not associated with any threshold elevation of cTnI. The frequencies of PMI according to the fourth UDMI, ARC-2, and SCAI definitions were 19.4%, 12.3%, and 8.6%, respectively. PMI by all 3 definitions was significantly associated with 3-year CV death, with the SCAI definition having the strongest relationship (aHR, 6.34; 95% CI, 2.47-16.27) compared with those of ARC-2 (aHR, 2.82; 95% CI, 1.15-6.96) and fourth UDMI (aHR, 2.65; 95% CI, 1.14-6.14).
Conclusions:
In patients with recent MI undergoing PCI for LMCAD, an incremental elevation in postprocedural CK-MB of ≥10× the upper reference limit as a stand-alone measure was strongly predictive of 3-year CV and all-cause death, whereas no cTnI elevations of any level were prognostic. All 3 contemporary PMI definitions in widespread use were associated with 3-year mortality after PCI in this high-risk cohort, with the SCAI definition having the strongest relationship with subsequent death.
Insights
Periprocedural myocardial infarction (PMI) after PCI for left main disease in recent MI patients is linked to death. A high CK-MB rise strongly predicts mortality, while SCAI definition best identifies high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Periprocedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) for left main coronary artery disease (LMCAD) can be particularly harmful in patients with recent myocardial infarction (MI).
- Assessing the incidence and prognostic significance of PMI, using various definitions and biomarker thresholds, is crucial in this high-risk population.
Purpose of the Study:
- To determine the rates of PMI after PCI for LMCAD in patients with recent MI.
- To evaluate the prognostic relevance of different PMI definitions and biomarker thresholds on long-term mortality.
Main Methods:
- Retrospective analysis of 442 patients undergoing PCI for LMCAD between 2004-2016, with recent MI.
- Adjudication of PMI using Society for Cardiovascular Angiography & Interventions (SCAI), Academic Research Consortium 2 (ARC-2), and fourth Universal Definition of Myocardial Infarction (UDMI) criteria.
- Assessment of 3-year cardiovascular (CV) and all-cause death rates as primary and secondary endpoints.
Main Results:
- An incremental post-PCI rise in creatine kinase-myocardial band (CK-MB) ≥10× the upper reference limit was significantly associated with 3-year CV death (aHR, 7.96).
- Cardiac troponin I (cTnI) elevations were not associated with CV death.
- PMI rates were 19.4% (UDMI), 12.3% (ARC-2), and 8.6% (SCAI). All definitions predicted 3-year CV death, with SCAI showing the strongest association (aHR, 6.34).
Conclusions:
- In patients with recent MI undergoing PCI for LMCAD, a substantial CK-MB elevation (≥10× URL) is a strong predictor of 3-year mortality.
- Contemporary PMI definitions (UDMI, ARC-2, SCAI) are associated with 3-year mortality, with the SCAI definition demonstrating the strongest prognostic relationship.
- No cTnI elevation levels were found to be prognostic in this cohort.
