Varying Definitions for Periprocedural Myocardial Infarction Alter Event Rates and Prognostic Implications

Abstract

BackgroundPeriprocedural myocardial infarction (PMI) has had several definitions in the last decade, including the Society for Cardiovascular Angiography and Interventions (SCAI) definition, that requires marked biomarker elevations congruent with surgical PMI criteria.Methods and ResultsThe aim of this study was to examine the definition‐based frequencies of PMI and whether they influenced the reported association between PMI and increased rates of late death/ myocardial infarction (MI). We studied 742 patients; 492 (66%) had normal troponin T (TnT) levels and 250 (34%) had elevated, but stable or falling, TnT levels. PMI, using the 2007 and the 2012 universal definition, occurred in 172 (23.2%) and in 99 (13.3%) patients, respectively, whereas 19 (2.6%) met the SCAI PMI definition (P<0.0001). Among patients with PMI using the 2012 definition, occlusion of a side branch ≤1 mm occurred in 48 patients (48.5%) and was the most common angiographic finding for PMI. The rates of death/MI at 2 years in patients with, compared to those without, PMI was 14.7% versus 10.1% (P=0.087) based on the 2007 definition, 16.9% versus 10.3% (P=0.059) based on the 2012 definition, and 29.4% versus 10.7% (P=0.015) based on the SCAI definition.ConclusionIn this study, PMI, according to the SCAI definition, was associated with more‐frequent late death/MI, with ≈20% of all patients, who had PMI using the 2007 universal MI definition, not having SCAI‐defined PMI. Categorizing these latter patients as SCAI‐defined no PMI did not alter the rate of death/MI among no‐PMI patients.

Clinical Predictors of Risk for Decreased Cardiac Tissue Perfusion After Percutaneous Coronary Intervention: A Retrospective Cohort Study

“…To the best of our knowledge, this is the first cohort study investigating the predictors of DCTP. The prevalence of DCTP during a 7‐year period was found to be 12.1%, which coincides with the prevalence range of PMI worldwide (Arai et al., ; Chen et al., ; Christensen et al., ; Idris et al., ; Mäkikallio et al., ; Prasad & Herrmann, ; Tsabedze et al., ; Wessler et al., ; Yamaji et al., ). However, the interpretation of this information must be done with caution, considering the several definitions on PMI used by different studies.…”

“…After PCI, an elevation of cardiac biomarkers above three times their basal values is expected (CathPCI Registry, ). However, periprocedural myocardial infarction (PMI) after PCI, remains a common complication in 2.6–38.8% of cases worldwide (Arai et al., ; Chen et al., ; http://Christensen, http://Huang, http://Torp-Pedersen, http://Trydal, & http://Ravkilde, ; Idris et al., ; Mäkikallio et al., ; Prasad & Herrmann, ; Tsabedze et al., ; Wessler et al., ; Yamaji et al., ).…”

Incidence and Determinants of Complications in Rotational Atherectomy

“…Periprocedural myocardial infarction was not included in the composite outcomes because a clear definition of periprocedural myocardial infarction was not available at the time of this study. Idris et al 24 reported that the incidence of periprocedural myocardial infarction varied widely in a single group of patients depending on the definition used (2.6% by Society for Cardiovascular Angiography and Interventions [SCAI] definition to 23.2% by 2007 universal myocardial infarction definition). Furthermore, it seemed impractical to collect meaningful information on periprocedural myocardial infarction from over 600 institutions across the nation in the present study.…”

Risk stratification of periprocedural myocardial infarction after percutaneous coronary intervention: Analysis based on the SCAI definition

“…Compared with the universal definition and the third universal definition, the SCAI definition requires much greater biomarker elevations. One recent study showed that SCAI‐defined PMI was associated with more late death and myocardial infarction than PMI diagnosed by other definitions . However, few large‐sample studies have attempted to predict the incidence and risk of SCAI‐defined PMI.…”