Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: An expert consensus document from the society for cardiovascular angiography and interventions (SCAI)

Moussa, Issam; Klein, Lloyd W.; Shah, Binita; Mehran, Roxana; Mack, Michael J.; Brilakis, Emmanouil S.; Reilly, John P.; Zoghbi, Gilbert J.; Holper, Elizabeth M.; Stone, Gregg W.

doi:10.1002/ccd.25135

Cited by 223 publications

(290 citation statements)

References 106 publications

(113 reference statements)

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“…T h e ne w e ngl a nd jou r na l o f m e dicine of reinfarction that we used in our study, a criterion that was in agreement with the third universal definition of myocardial infarction and used troponin as the preferred biomarker of myocardial necrosis, 18,19 even though it also required the presence of new symptoms or signs of myocardial ischemia. The lower rate of bleeding in the bivalirudin group than in the heparin group among patients with acute coronary syndromes who were undergoing PCI was associated with lower mortality, a finding that was consistent with those in the HORIZONS-AMI trial 7 and a pooled analysis of results from the HORIZONS-AMI trial and the European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial.…”

Section: Discussionmentioning

confidence: 79%

Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes

et al. 2015

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BACKGROUNDConflicting evidence exists on the efficacy and safety of bivalirudin administered as part of percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome. METHODSWe randomly assigned 7213 patients with an acute coronary syndrome for whom PCI was anticipated to receive either bivalirudin or unfractionated heparin. Patients in the bivalirudin group were subsequently randomly assigned to receive or not to receive a post-PCI bivalirudin infusion. Primary outcomes for the comparison between bivalirudin and heparin were the occurrence of major adverse cardiovascular events (a composite of death, myocardial infarction, or stroke) and net adverse clinical events (a composite of major bleeding or a major adverse cardiovascular event). The primary outcome for the comparison of a post-PCI bivalirudin infusion with no post-PCI infusion was a composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events. RESULTSThe rate of major adverse cardiovascular events was not significantly lower with bivalirudin than with heparin (10.3% and 10.9%, respectively; relative risk, 0.94; 95% confidence interval [CI], 0.81 to 1.09; P = 0.44), nor was the rate of net adverse clinical events (11.2% and 12.4%, respectively; relative risk, 0.89; 95% CI, 0.78 to 1.03; P = 0.12). Post-PCI bivalirudin infusion, as compared with no infusion, did not significantly decrease the rate of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events (11.0% and 11.9%, respectively; relative risk, 0.91; 95% CI, 0.74 to 1.11; P = 0.34). CONCLUSIONSIn patients with an acute coronary syndrome, the rates of major adverse cardiovascular events and net adverse clinical events were not significantly lower with bivalirudin than with unfractionated heparin. The rate of the composite of urgent target-vessel revascularization, definite stent thrombosis, or net adverse clinical events was not significantly lower with a post-PCI bivalirudin infusion than with no post-PCI infusion. (Funded by the Medicines Company and Terumo Medical; MATRIX ClinicalTrials.gov number, NCT01433627.)

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Section: Discussionmentioning

confidence: 79%

Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes

et al. 2015

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“…The ULN for CK-MB and troponin at our institution was 6.3 ng/mL and 0.04 ng/mL, respectively. PMI was also defined according to the Society of Cardiovascular Angiography and Interventions (SCAI) as CK-MB increase !10Â ULN [6]. To determine case complexity, the J-CTO (Multicenter CTO Registry of Japan) score was calculated in all patients, which has a range from 0 to 5 as follows: easy (J-CTO ¼ 0), intermediate (J-CTO ¼ 1), difficult (J-CTO ¼ 2), and very difficult (J-CTO !…”

Section: Definitionsmentioning

confidence: 99%

Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

Stetler¹,

Karatasakis

Christakopoulos

et al. 2016

Cathet Cardio Intervent

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Objectives: We sought to evaluate the impact of crossing strategy on the incidence of periprocedural myocardial infarction (PMI) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Background: The optimal technique for crossing coronary CTOs remains controversial. Methods: We retrospectively examined the incidence of PMI among 184 consecutive patients who underwent CTO PCI at our institution between 2012 and 2015. Creatine kinase-myocardial band fraction (CK-MB) and troponin were measured before and after PCI in all patients. PMI was defined as CK-MB increase !33 upper limit of normal (ULN). Results: Mean age was 65 6 8 years, 98% of patients were men, 57% had diabetes mellitus, 36% were current smokers, 38% had prior heart failure, 31% had prior coronary artery bypass graft surgery (CABG), and 55% had prior PCI. The retrograde approach was used in 38% of cases. As compared with antegrade wire escalation and antegrade dissection/re-entry, use of the retrograde approach was associated with higher J-CTO (Multicenter CTO Registry of Japan) scores (P < 0.0001), higher frequency of moderate or severe calcification (P 5 0.0061), longer CTO length (P < 0.0001), more frequent proximal cap ambiguity (P < 0.0001), and lower technical (P 5 0.0007) and procedural (P 5 0.0014) success. The frequency of PMI for the antegrade-only and retrograde cases was 10% and 33%, respectively (P 5 0.0001). On multivariate analysis, use of the retrograde approach and moderate/severe calcification were independently associated with higher incidence of PMI. Conclusions: As compared with antegrade-only crossing techniques, the retrograde approach is used in patients with more complex anatomy but may carry higher risk for PMI. V C 2016 Wiley Periodicals, Inc.

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“…A successful angiographic result was achieved in all patients. A slight postprocedural elevation of cardiac biomarker values was observed in all cases, 5 (6.8%) of them were classified as a PCI related MI according to the consensus criteria (10). The mean post procedural FFR was 0.88 ± 0.06.…”

Section: Resultsmentioning

confidence: 90%

FFR guided PCI on long coronary lesions: 2-year clinical results with 2nd or newer generation DES

Baranauskas

Bajoras

Budrys

et al. 2016

AML

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Background. Despite improvements in drug-eluting stent (DES) technology, treatment strategies for long coronary artery lesions remain a controversial issue. The aim of our study was to evaluate the long-term clinical results after FFR guided PCI on long coronary lesions.Materials and methods. A total of 74 consecutive patients with significant (mean FFR 0.61 ± 0.11) coronary artery lesions ≥30 mm in length were included in the prospective study. All patients were treated with FFR guided PCI implanting newer generation Biolimus, Everolimus or Zotarolimus eluting stents. Clinical endpoints -target vessel revascularization (TVR) and major adverse cardiac events (MACE) -were recorded at 1 and 2 years.Results. 100% angiographic procedure success was achieved, the mean post procedural FFR was 0.88 ± 0.06. At 2-year follow-up, 6 (8.1%) patients had ischemia driven TVR, all within the first 12 months. There were no target vessel related acute coronary syndromes and definite stent thromboses in the study group. At 2 years, the total MACE rate was 29.7%. There was a trend towards a higher TVR rate in patients with overlapping DES vs single DES implanted (9.6 vs 4.5%, p = 0.6). On regression analysis, the total stent length had no influence on the TVR rate.Conclusions. At 2 years after stenting long coronary lesions with newer generation DES the TVR rate was 8.1%, which is acceptable in the high cardiovascular risk population with diffuse coronary artery disease. The total stent length did not affect the long-term clinical outcomes.

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Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: An expert consensus document from the society for cardiovascular angiography and interventions (SCAI)

Cited by 223 publications

References 106 publications

Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes

Bivalirudin or Unfractionated Heparin in Acute Coronary Syndromes

Impact of crossing technique on the incidence of periprocedural myocardial infarction during chronic total occlusion percutaneous coronary intervention

FFR guided PCI on long coronary lesions: 2-year clinical results with 2nd or newer generation DES

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