Implications of Periprocedural Myocardial Biomarker Elevations and Commonly Used MI Definitions After Left Main PCI

Wang, Hao‐Yu; Xu, Bo; Dou, Kefei; Guan, Changdong; Song, Lei; Huang, Yunfei; Zhang, Rui; Xie, Lihua; Zhang, Min; Yan, Hongbing; Yang, Wei; Wu, Yongjian; Yang, Yuejin; Qiao, Shubin; Gao, Runlin; Stone, Gregg W.

doi:10.1016/j.jcin.2021.05.006

Cited by 36 publications

(39 citation statements)

References 24 publications

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“…13 Another study of patients with left main PCI showed that SCAI-defined PMI was independently related to subsequent cardiovascular and all-cause mortality, whereas PMI was defined according to the Academic Research Consortium-2 (ARC-2) and Fourth UDMI definitions was not. 14 The findings of these studies give the impression that large periprocedural infarctions (detected by significant elevation of CK-MB or cTnI levels) are powerful determinants of longterm mortality, whereas microinfarcts were not, as confirmed by the findings of previous studies. [15][16][17] In fact, prominent CK-MB elevation is most commonly caused by severe complications such as sidebranch occlusion, which can cause massive MI and lead to poor clinical outcomes.…”

Section: Discussionsupporting

confidence: 56%

“…In the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) trial, PMI, as defined by both the Society for Cardiovascular Angiography and Interventions (SCAI) and Fourth UDMI criteria, was independently associated with all‐cause mortality at 1 and 10 years 13 . Another study of patients with left main PCI showed that SCAI‐defined PMI was independently related to subsequent cardiovascular and all‐cause mortality, whereas PMI was defined according to the Academic Research Consortium‐2 (ARC‐2) and Fourth UDMI definitions was not 14 . The findings of these studies give the impression that large periprocedural infarctions (detected by significant elevation of CK‐MB or cTnI levels) are powerful determinants of long‐term mortality, whereas microinfarcts were not, as confirmed by the findings of previous studies 15–17 .…”

Section: Discussionmentioning

confidence: 99%

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Predictors and clinical significance of periprocedural myocardial infarction following rotational atherectomy

Hong

et al. 2022

Cathet Cardio Intervent

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Objectives: To investigate the potential predictors and clinical significance of periprocedural myocardial infarction (PMI), as defined by the latest Fourth Universal Definition of Myocardial Infarction (2018), following rotational atherectomy (RA).Background: PMI is not uncommon in patients undergoing RA, although the predictors and prognostic impact are unknown.Methods: Data from 229 consecutive patients who had undergone RA before drugeluting stent (DES) implantation in a single center were analyzed. Patients' demographic information, clinical, angiographic, and procedural characteristics, and 1-year follow-up outcomes were collected retrospectively. Results:The overall incidence of PMI in patients undergoing RA was 48.5%. Age

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Predictors and clinical significance of periprocedural myocardial infarction following rotational atherectomy

Hong

et al. 2022

Cathet Cardio Intervent

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“…Details on data collection, study definitions, and follow-up have been previously reported and were included in the Supplemental Material. 14,15…”

Section: Methodsmentioning

confidence: 99%

“…Details on data collection, study definitions, and follow-up have been previously reported and were included in the Supplemental Material. 14,15 Procedures PCI was performed according to standard practices. Unfractionated heparin or bivalirudin was used for anticoagulation during the procedure.…”

Section: Study Populationmentioning

confidence: 99%

“…The results of this study should be considered in light of some important limitations. First, this was a retrospective analysis from a large-volume single center with extensive experience with LM PCI, 14,15 the generalizability of our observational study was limited. In view of the post hoc nature of the analysis, our findings should be considered strictly as exploratory and hypothesis generating.…”

Section: Limitationsmentioning

confidence: 99%

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New Insights Into Long- Versus Short-Term Dual Antiplatelet Therapy Duration in Patients After Stenting for Left Main Coronary Artery Disease: Findings From a Prospective Observational Study

Wang

Dou

Guan

et al. 2022

Circ: Cardiovascular Interventions

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Background: The appropriate duration of dual antiplatelet therapy (DAPT) and risk-benefit ratio for long-term DAPT in patients with left main (LM) disease undergoing percutaneous coronary intervention remains uncertain. Methods: Four thousand five hundred sixty-one consecutive patients with stenting of LM disease at a single center from January 2004 to December 2016 were enrolled. Decision to discontinue or remain on DAPT after 12 months was left to an individualized decision-making based on treating physicians by weighing the patient’s risks of ischemia versus bleeding and considering patient preference. The primary outcome was a composite of death, myocardial infarction, stent thrombosis, or stroke at 3 years. Key safety outcome was 3-year rate of Bleeding Academic Research Consortium 2, 3, or 5 bleeding. Results: Of 3865 patients free of ischemic and bleeding events at 12 months, 1727 (44.7%) remained on DAPT (mostly clopidogrel based [97.7%]) beyond 12 months after LM percutaneous coronary intervention. DAPT>12-month versus ≤12-month DAPT was associated with a significant reduced risk of 3-year primary outcome (2.6% versus 4.6%; adjusted hazard ratio: 0.59 [95% CI, 0.41–0.84]). The same trend was found for other ischemic end points: death (0.9% versus 3.0%; P log-rank <0.001), cardiovascular death (0.5% versus 1.7%; P log-rank =0.001), myocardial infarction (0.8% versus 1.9%; P log-rank =0.005), and stent thrombosis (0.4% versus 1.1%; P log-rank =0.017). The key safety end point was not significantly different between 2 regimens (1.8% versus 1.6%; adjusted hazard ratio: 1.07 [95% CI, 0.65–1.74]). The effect of DAPT>12 month on primary and key safety outcomes was consistent across clinical presentations, high bleeding risk, P2Y 12 inhibitor, and LM bifurcation percutaneous coronary intervention approach. Conclusions: In a large cohort of patients free from clinical events during the first year after LM percutaneous coronary intervention and at low apparent future bleeding risk, an individualized patient-tailored approach to longer duration (>12 month) of DAPT with aspirin plus a P2Y 12 inhibitor (mostly clopidogrel) improved both composite and individual efficacy outcomes by reducing ischemic risk, without a concomitant increase in clinically relevant bleeding.

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A New Scoring System Predicting Side-Branch Occlusion in Patients Undergoing Left Main Bifurcation Intervention: The LM V-RESOLVE Score

He,

Cai,

Wang

et al. 2024

Canadian Journal of Cardiology

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Implications of Periprocedural Myocardial Biomarker Elevations and Commonly Used MI Definitions After Left Main PCI

Cited by 36 publications

References 24 publications

Predictors and clinical significance of periprocedural myocardial infarction following rotational atherectomy

Predictors and clinical significance of periprocedural myocardial infarction following rotational atherectomy

New Insights Into Long- Versus Short-Term Dual Antiplatelet Therapy Duration in Patients After Stenting for Left Main Coronary Artery Disease: Findings From a Prospective Observational Study

A New Scoring System Predicting Side-Branch Occlusion in Patients Undergoing Left Main Bifurcation Intervention: The LM V-RESOLVE Score

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