Author + information
- Yong-Hoon Yoon1,
- Sang Yong Om1,
- Hanbit Park2,
- Minsoo Kim3,
- Sang-Cheol Cho2,
- Osung Kwon1,
- Ungjeong Do2,
- Kyusup Lee4,
- Do-yoon Kang1,
- Cheol Hyun Lee5,
- Pil Hyung Lee1,
- Jung-Min Ahn1,
- Duk-Woo Park1,
- Soo-Jin Kang1,
- Seung-Whan Lee1,
- Young-Hak Kim1,
- Cheol Whan Lee1,
- Seong-Wook Park1 and
- Seung-Jung Park1
This study aims to evaluate clinical impact of periprocedural myocardial infarction(PMI) according to various definitions after coronary intervention with drug-eluting stent(DES).
Out of a total of 17,557 patients who underwent percutaneous coronary intervention (PCI) in a prospective IRIS-DES registry, 11,208 patients were selected for the analysis after exclusion of patients with ST elevation myocardial infarction(MI) or baseline elevation of CK-MB before intervention. The primary endpoint was the composite of cardiovascular death, MI or target-vessel revascularization(TVR). PMI was defined as the elevation of CK-MB ≥10, ≥5 or ≥3 x URL after PCI.
During 5 years of follow-up, PMI occurred in 184, 393 and 689 patients according to different definitions. After multivariable adjustment, only PMI defined as CK-MB ≥10 x URL was significant risk of the composite of cardiovascular death, MI or TVR. (adjusted hazard ratio [HR] 2.5, p<0.001 for CK-MB ≥10 x URL, adjusted HR 1.2, p=0.390 for CK-MB ≥5x URL, adjusted HR 1.2, p=0.218 for CK-MB ≥3 x URL). All definitions were related significantly with the occurrence of cardiovascular death (adjusted HR 4.2, p<0.001 for CK-MB ≥10 x URL, adjusted HR 2.1, p=0.021 for CK-MB ≥5x URL, adjusted HR 2.0, p=0.013 for CK-MB ≥3 x URL PMI). Only CK-MB ≥10 x URL PMI was the risk of TVR (adjusted HR 1.7, p=0.030). Any definition could not predict the occurrence of MI for follow-up period in multivariate analysis.
|PMI (≥10 x URL)||PMI (≥5 x URL)|
|Event rate||aHR (95% CI)||p||Event rate||aHR (95% CI)||p|
|MACE||17.0% vs 7.1%||1.9 (1.3-2.8)||<0.001||10.3% vs 7.2%||1.2 (0.8-1.6)||0.39|
|Cardiovascular mortality||5.9% vs 0.9%||4.2 (2.2-8.3)||<0.001||2.9% vs 0.9%||2.1 (1.1-4.1)||0.021|
|All-cause mortality||10.1% vs 5.1%||1.5 (0.9-2.2)||0.185||7.5% vs 5.1%||1.1 (0.7-1.6)||0.754|
|MI||3.6% vs 1.1%||2.2 (0.9-5.0)||0.072||2.2% vs 1.1%||1.4 (0.7-2.9)||0.399|
|TVR||11.8% vs 5.8%||1.7 (1.1-2.6)||0.030||7.5% vs 5.8%||1.1 (0.7-1.6)||0.717|
|Stroke||3.4% vs 2.1%||1.5 (0.6-3.3)||0.362||2.9% vs 2.0%||1.3 (0.7-2.4)||0.416|
Among all definitions, PMI defined as CK-MB ≥10 x URL was the best prognostic predictor for major adverse cardiovascular outcomes after PCI in DES era.
CORONARY: PCI Outcomes