虚血性心疾患（CCS）患者に対する待機的PCIにおける周術期心筋梗塞の定義と予測：ALPHEUS-MI試験

PCI-related myocardial infarction (MI) or injury are frequent events associated with long-term ischemic outcomes and mortality. The objective of the pre-specified 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 endpoint combining ARC type 4a/4b MI and major myocardial injury (post-PCI troponin > 5 x URL) 2/ the ALPHEUS main secondary endpoint combining ARC type 4a/4b MI and any myocardial injury corresponding to the 4^th universal definition of MI 3/ the ARC2-SCAI definition of significant myocardial injury and, 4/ the ARC-2 definition of periprocedural MI.

The primary and secondary endpoints of the ALPHEUS trial occurred in 35.9% and 77.2% of the patients, respectively. The ARC2-SCAI periprocedural MI occurred in 2.0% of the patients and the ARC2 significant myocardial injury in 3.2% of the patients. With all endpoint 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 (>60mm) was the only common correlate of MI or myocardial injury was (adjusted OR ranging between 2.2 and 6.0 for the four definitions).

The accumulation of high-risk features exposes patients to periprocedural MI/injury within all definitions. Extensive atherosclerosis, leading to longer coronary stents, plays a major role in the occurrence of periprocedural MI/injury (Substudy of ALPHEUS trial NCT02617290).