Author + information
- Michael Butler,
- Matthew Sacrinty,
- William Little,
- Robert Applegate,
- Michael Kutcher,
- Renato Santos and
- Sanjay Gandhi
Percutaneous coronary intervention–related myocardial infarction (PCI–MI), historically defined as creatine kinase MB (CKMB) > 3x normal within 24 hours post–PCI, is associated with worse clinical outcomes. New guidelines arbitrarily define PCI–MI using cardiac troponin > 5×99th percentile of normal. It is unclear if this new criteria also conveys a worse prognosis using second–generation cardiac troponin I (cTnI) assays.
771 patients with normal baseline pre–procedure cTnI values underwent PCI at a single center (Wake Forest Baptist Medical Center) between June 2008 and December 2010. Serial CKMB and cTnI were obtained through 24 hours post–PCI. PCI–MI by cTnI was defined as peak cTnI >5×99th percentile and PCI–MI by CKMB was defined as peak CKMB >3x normal. Major adverse cardiac events (MACE) were evaluated at one year using Kaplan–Meier analysis.
Within 24 hours post–PCI, 280 patients (36%) met criteria for PCI–MI by cTnI, while 36 patients (5%) met criteria for PCI–MI by CKMB. PCI–MI by CKMB was associated with a three–fold increase in mortality (9.0% PCI–MI vs 2.9% no PCI–MI, p=0.046), while PCI–MI by cTnI was not associated with increased mortality (3.0% PCI–MI vs 3.3% no PCI–MI, p=0.85). MACE comparisons are shown in the figure.
PCI–MI defined by CKMB elevation is associated with increased risk of mortality and MACE at one year, while PCI–MI defined by cTnI elevation does not predict adverse outcomes.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Acute Coronary Syndrome and Acute Myocardial Infarction
Abstract Category: 40. TCT@ACC–i2: ACS/AMI/Hemodynamic Support
Presentation Number: 2113M–255
- 2013 American College of Cardiology Foundation