Definition and Prediction of Periprocedural Myocardial Infarction in Elective Percutaneous Coronary Intervention: The...

Percutaneous coronary intervention (PCI)-related myocardial infarction (MI) or injury are frequent events associated with long-term ischemic outcomes and mortality. The objective of the prespecified Assessment of Loading with the P2Y₁₂ inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting (ALPHEUS-MI) study was to describe factors associated with periprocedural MI.

Within the trial population of 1883 patients with chronic coronary syndrome who underwent elective PCI, we analyzed periprocedural myocardial necrosis using: (1) the ALPHEUS primary end point; a combination of Academic Research Consortium (ARC) type 4a/4b MI and major myocardial injury (post-PCI troponin > 5 times the upper reference limit); (2) the ALPHEUS main secondary end point; a combination of ARC type 4a/4b MI and any myocardial injury corresponding to the fourth universal definition of MI; (3) the ARC-2/Society for Cardiovascular Angiography and Interventions definition of significant myocardial injury; and (4) the ARC-2 definition of periprocedural MI.

The primary and secondary end points of the ALPHEUS trial occurred in 35.9% and 77.2% of the patients, respectively. The ARC-2/Society for Cardiovascular Angiography and Interventions periprocedural MI occurred in 2.0% of the patients and the ARC-2 significant myocardial injury in 3.2% of the patients. With all end point definitions, event rates increased gradually with the number of high-risk features including patients' characteristics, complexity of the coronary lesion, and the complexity of the PCI procedure. After multivariable analysis, total length of stent implanted (> 60 mm) was the only common correlate of MI or myocardial injury (adjusted odds ratio ranging between 2.2 and 6.0 for the 4 definitions).

The accumulation of high-risk features exposes patients to periprocedural MI or injury within all definitions. Extensive atherosclerosis, which leads to longer coronary stents, plays a major role in the occurrence of periprocedural MI or injury.

NCT02617290.