Author + information
- Received December 30, 2008
- Revision received February 19, 2009
- Accepted March 24, 2009
- Published online July 28, 2009.
- Abhiram Prasad, MD⁎,
- Bernard J. Gersh, MB, ChB, DPhil, MD⁎,
- Michel E. Bertrand, MD†,
- A. Michael Lincoff, MD‡,
- Jeffrey W. Moses, MD§,
- E. Magnus Ohman, MD∥,
- Harvey D. White, MD¶,
- Stuart J. Pocock, PhD#,
- Brent T. McLaurin, MD⁎⁎,
- David A. Cox, MD††,
- Alexandra J. Lansky, MD§,
- Roxana Mehran, MD§ and
- Gregg W. Stone, MD§,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Gregg W. Stone, The Cardiovascular Research Foundation, Columbia University Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, New York 10032
Objectives The aim of this study was to evaluate the relative impact of spontaneously occurring and periprocedural myocardial infarction (MI) on survival after percutaneous coronary intervention (PCI).
Background The clinical significance of periprocedural MI after PCI remains uncertain.
Methods Outcomes during a 1-year follow-up were evaluated among 7,773 patients enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial with a non–ST-segment elevation acute coronary syndrome in whom PCI was performed.
Results Periprocedural MI developed in 466 patients (6.0%), and spontaneous MI unrelated to PCI subsequently developed in 200 patients (2.6%). Patients developing spontaneous and periprocedural MI compared with those patients without MI had significantly greater unadjusted rates of mortality at 30 days (5.0% vs. 3.2% vs. 0.8%, respectively, p < 0.0001) and at 1 year (16.0% vs. 6.0% vs. 2.6%, respectively, p < 0.0001). In a time-updated multivariable analysis, after adjusting for differences in baseline and procedural characteristics between the groups, we found that spontaneous MI was a powerful independent predictor of subsequent mortality (hazard ratio: 7.49, 95% confidence interval: 4.95 to 11.33, p < 0.0001), whereas periprocedural MI was not a significant predictor of mortality (hazard ratio: 1.30, 95% confidence interval: 0.85 to 1.98, p = 0.22).
Conclusions Among patients with acute coronary syndrome undergoing PCI, the spontaneous development of an MI unrelated to PCI is a powerful predictor of subsequent mortality. In contrast, periprocedural MI is a marker of baseline risk, atherosclerosis burden, and procedural complexity but in most cases does not have independent prognostic significance. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158)
The ACUITY trial was funded by The Medicines Company (Parsippany, New Jersey) and Nycomed (Roskilde, Denmark). Dr. Gersh is a consultant to and/or member of the Data Safety Monitoring Board for AstraZeneca, Bristol-Myers Squibb, Abbott Laboratories, and Boston Scientific and is a shareholder of CV Therapeutics. Dr. Lincoff has received research grants from The Medicines Company and Sanofi-Aventis. Dr. Ohman is a consultant for CV Therapeutics, Northpoint Domain, Pozen, WebMD, The Medicines Company, Inovise, Liposcience, Response Biomedical, Datascope, and Abioed; is a recipient of research grants from AstraZeneca, Bristol-Myers Squibb, CV Therapeutics, Daiichi Sankyo, Datascope, Eli Lilly, Sanofi-Aventis, Schering-Plough, and The Medicines Company; and is a shareholder of Inovise. For a complete listing including institutional disclosures, go to www.dcri.duke.edu/research/coi.jsp. Dr. White has received research grants from Sanofi-Aventis, Eli Lilly, The Medicines Company, National Institutes of Health, Pfizer, Roche, Johnson & Johnson, Schering-Plough, Merck Sharpe & Dohme, AstraZeneca, GlaxoSmithKline, and Daiichi Sankyo Pharma Development, and consulting fees from GlaxoSmithKline and Sanofi-Aventis. Dr. Pocock has received consulting fees from The Medicines Company. Dr. Cox is a member of the Speakers' Bureau of The Medicines Company. Dr. Mehran has been a consultant with Abbott and has received speaking honoraria from The Medicines Company, Lily/Daiichi Sankyo, Medtronic Vascular, Boston Scientific, Cordis Corp., and Sanofi-Aventis. Dr. Stone has received research grants from The Medicines Company, Boston Scientific, and Abbott Vascular.
- Received December 30, 2008.
- Revision received February 19, 2009.
- Accepted March 24, 2009.
- American College of Cardiology Foundation