Frequency and Outcomes of Periprocedural MI in Patients With Chronic Coronary Syndromes Undergoing PCI

Ueki, Yasushi; Otsuka, Tatsuhiko; Bär, Sarah; Koskinas, K; Heg, Dik; Häner, Jonas; Siontis, George C.M.; Praz, Fabien; Hunziker, Lukas; Lanz, Jonas; Stortecky, Stefan; Pilgrim, Thomas; Losdat, Sylvain; Windecker, Stephan; Räber, Lorenz

doi:10.1016/j.jacc.2021.11.047

Cited by 34 publications

(20 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The frequency of procedural MI and subsequent death in a general population of patients with chronic coronary disease undergoing a revascularization procedure can vary depending on the definition of MI used. [19][20][21][22][23][24] Two recent studies of patients undergoing percutaneous coronary intervention or coronary artery bypass grafting using the UDMI, Academic Research Consortium-2, and Society for Cardiovascular Angiography and Interventions showed more procedural MIs were detected using the UDMI definition compared with the Academic Research Consortium-2 or Society for Cardiovascular Angiography and Interventions definition. 23,24 All 3 definitions were associated with increased death rates although death tended to be greater with the Academic Research Consortium-2 or Society for Cardiovascular Angiography and Interventions definitions in patients undergoing percutaneous coronary intervention and similar in patients undergoing coronary artery bypass grafting.…”

Section: Procedural MImentioning

confidence: 99%

“…[19][20][21][22][23][24] Two recent studies of patients undergoing percutaneous coronary intervention or coronary artery bypass grafting using the UDMI, Academic Research Consortium-2, and Society for Cardiovascular Angiography and Interventions showed more procedural MIs were detected using the UDMI definition compared with the Academic Research Consortium-2 or Society for Cardiovascular Angiography and Interventions definition. 23,24 All 3 definitions were associated with increased death rates although death tended to be greater with the Academic Research Consortium-2 or Society for Cardiovascular Angiography and Interventions definitions in patients undergoing percutaneous coronary intervention and similar in patients undergoing coronary artery bypass grafting. 23,24 Patients with advanced CKD are often underrepresented in studies of this type, and additional research on different MI definitions and their subsequent impact on death and cardiovascular death is needed.…”

Section: Procedural MImentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial

Chaitman

Cyr

Alexander

et al. 2022

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background: ISCHEMIA-CKD (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches—Chronic Kidney Disease) reported an initial invasive treatment strategy did not reduce the risk of death or nonfatal myocardial infarction (MI) compared with a conservative treatment strategy in patients with advanced chronic kidney disease, stable coronary disease, and moderate or severe myocardial ischemia. The cumulative frequency of different MI type after randomization and subsequent prognosis have not been reported. Methods: MI classification was based on the Third Universal Definition for MI. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary MI definition used cTn (cardiac troponin); both definitions included elevated biomarker-only events with higher thresholds than nonprocedural MIs. The cumulative frequency of MI type according to treatment strategy was determined. The association of MI with subsequent all-cause death and new dialysis initiation was assessed by treating MI as a time-dependent covariate. Results: The 3-year incidence of type 1 or 2 MI with the primary MI definition was 11.2% in invasive treatment strategy and 13.6% in conservative treatment strategy (hazard ratio [HR], 0.66 [95% CI, 0.42–1.02]). Procedural MIs were more frequent in invasive treatment strategy and accounted for 9.8% and 28.3% of all MIs with the primary and secondary MI definitions, respectively. Patients had an increased risk of all-cause death after type 1 MI (adjusted HR, 4.35 [95% CI, 2.73–6.93]) and after procedural MI with the primary (adjusted HR, 2.75 [95% CI, 0.99–7.60]) and secondary MI definitions (adjusted HR, 2.91 [95% CI, 1.73–4.88]). Dialysis initiation was increased after a type 1 MI (HR, 6.45 [95% CI, 2.59–16.08]) compared with patients without an MI. Conclusions: In ISCHEMIA-CKD, the invasive treatment strategy had higher rates of procedural MIs, particularly with the secondary MI definition, and lower rates of type 1 and 2 MIs. Procedural MIs, type 1 MIs, and type 2 MIs were associated with increased risk of subsequent death. Type 1 MI increased the risk of dialysis initiation. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01985360.

show abstract

Section: Procedural MImentioning

confidence: 99%

Section: Procedural MImentioning

confidence: 99%

Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial

Chaitman

Cyr

Alexander

et al. 2022

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

show abstract

“…Further objections to the document concern the absence of comparative data on prognostic information with alternative PMI definitions such as those proposed by ARC-2 and SCAI [38]. Recently, Ueki et al [30] assessed PMI according to the third and fourth UDMI, ARC-2 and SCAI criteria based on high-sensitivity cTn in patients with stable coronary disease treated with PCI enrolled into the Bern PCI registry. This analysis represents the first detailed evaluation of contemporary PMI definitions in elective PCI patients based on systematic hs-cTn measurements and systematic assessment of ancillary criteria in a large real-world PCI population.…”

Section: The European Society Of Cardiology (Esc) Consensus Document ...mentioning

confidence: 99%

Periprocedural Myocardial Infarction following Elective Percutaneous Coronary Interventions

Landi¹,

Montalto²,

Servi³

2022

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

The prognostic relevance of periprocedural myocardial infarction (PMI) in patients with chronic coronary syndrome undergoing percutaneous coronary intervention (PCI) is still matter of debate, particularly regarding the type (cardiac troponin or creatin kinase-MB) and different thresholds of biomarkers elevation, as the importance of associated ancillary criteria of ischemia or concomitant angiographic complications. There are still uncertainties regarding the value of PMI as event which is prognostically equivalent to spontaneous myocardial infarction or if it simply represents a marker of baseline risk, atherosclerotic burden and procedural complexity. In the present review, we will present the mechanisms and predictors of PMI occurring during PCI and potential treatment strategies to reduce its occurrence. We will also overview all commonly adopted definitions of PMI, which carry different prevalence and prognostic implications in daily practice and clinical trials. Finally, we will discuss the impact of different PMI definitions on the interpretation of trials results, emphasizing the importance of adequate endpoints selection in the planning and interpretation of clinical trials.

show abstract

“…Following a PCI or CABG, several early or late complications can occur, potentially impairing prognosis. These complications include myocardial injury/procedural myocardial infarction [ 50 , 51 , 52 ], early/late stent thrombosis [ 53 ], stent or surgical graft failures [ 54 , 55 ], acute kidney injury [ 56 ], and others. Moreover, in patients undergoing a PCI, dual antiplatelet therapy (DAPT) administration following the procedure can be associated with minor and major bleeding [ 57 ].…”

Section: The Relationship Between Ffr and Clinical Outcomesmentioning

confidence: 99%

Fractional Flow Reserve-Guided Coronary Revascularization: Evidence from Randomized and Non-Randomized Studies

et al. 2022

View full text Add to dashboard Cite

Simple visual estimation of coronary angiography is limited by several factors that can hinder the proper classification of coronary lesions. Fractional flow reserve (FFR) is the most widely used tool to perform a physiological evaluation of coronary stenoses. Compared to isolated angiography, FFR has been demonstrated to be more effective in selecting those lesions associated with myocardial ischemia and, accordingly, impaired outcomes. At the same time, deferring coronary intervention in those lesions that do not show ischemic FFR values has proven safe and not associated with adverse events. Despite a major randomized clinical trial (RCT) and several non-randomized studies showing that FFR-guided revascularization could be superior to isolated angiography in improving clinical outcomes, subsequent RCTs have reported conflicting results. In this review, we summarize the principles behind FFR and the data currently available in the literature, highlighting the main differences between randomized and non-randomized studies that investigated this topic.

show abstract

Frequency and Outcomes of Periprocedural MI in Patients With Chronic Coronary Syndromes Undergoing PCI

Cited by 34 publications

References 27 publications

Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial

Cardiovascular and Renal Implications of Myocardial Infarction in the ISCHEMIA-CKD Trial

Periprocedural Myocardial Infarction following Elective Percutaneous Coronary Interventions

Fractional Flow Reserve-Guided Coronary Revascularization: Evidence from Randomized and Non-Randomized Studies

Contact Info

Product

Resources

About