Author + information
- Shmuel Chen1,
- Ori Ben-Yehuda2,
- Thomas McAndrew3,
- Ioanna Kosmidou4,
- Bjorn Redfors3,
- Marie-Claude Morice5,
- David Kandzari6,
- Adrian Banning7,
- Ovidiu Dressler3,
- Martin Leon8,
- A. Pieter Kappetein9,
- Joseph Sabik10,
- Patrick Serruys11 and
- Gregg Stone12
- 1CRF, New York, New York, United States
- 2Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York, United States
- 3Cardiovascular Research Foundation, New York, New York, United States
- 4Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, United States
- 5CERC, Massy, France
- 6Piedmont Heart Institute, Atlanta, Georgia, United States
- 7John Radcliffe Hospital, Oxford, United Kingdom
- 8Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 9Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 10Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 11Imperial College, London, United Kingdom
- 12Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
The prognostic implications of periprocedural MI (MIpp) in pts undergoing PCI and CABG remain controversial and vary based on the threshold for biomarker elevations used in the definition. The EXCEL trial enrolled 1905 pts with left main (LM) disease and low or intermediate SYNTAX scores to PCI with everolimus-eluting stents vs. CABG. CK-MB was routinely collected at 12 ± 2 and 24 ± 2 hrs post procedure.
We compared 3-year cardiovascular (CV) and total mortality in pts with vs. without MIpp by varying peak CK-MB thresholds: >3× ULN, >5× ULN, and >10× ULN. KM curves were constructed for different cut-offs and by treatment (all, CABG, PCI).
MIpp was associated with 3-year CV and all-cause mortality if peak CK-MB was >10× ULN (CV mortality with vs. without MIpp 11.9% vs. 3.8%; HR 3.47 [95% CI 1.58, 7.61]; p<0.001; all-cause mortality 15.0% vs. 6.9% respectively; HR 2.48 [95% CI 1.25, 4.90]; p<0.001). CK-MB >10× ULN was also associated with CV mortality in the PCI and CABG groups individually (HR 5.07 [95% CI 1.55, 16.6] and HR 2.85 [95% CI 1.00, 8.16] respectively). MIpp defined by >3× ULN and >5× ULN were not significantly associated with increased CV or all-cause mortality.
In the EXCEL trial, MIpp defined by CK-MB elevation >10× ULN was associated with increased 3-year CV and all-cause mortality after LM revascularization by PCI and CABG. Lower thresholds were not significantly associated with increased mortality.
CORONARY: PCI Outcomes