Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data

Johanne Silvain; Michel Zeitouni; Valeria Paradies; Huili L Zheng; Gjin Ndrepepa; Claudio Cavallini; Dimitri N Feldman; Samin K Sharma; Julinda Mehilli; Sebastiano Gili; Emanuele Barbato; Giuseppe Tarantini; Sze Y Ooi; Clemens von Birgelen; Allan S Jaffe; Kristian Thygesen; Gilles Montalescot; Heerajnarain Bulluck; Derek J Hausenloy

doi:10.1093/eurheartj/ehaa885

Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data

Johanne Silvain, Michel Zeitouni, Valeria Paradies, Huili L Zheng, Gjin Ndrepepa, Claudio Cavallini, Dimitri N Feldman, Samin K Sharma, Julinda Mehilli, Sebastiano Gili, Emanuele Barbato, Giuseppe Tarantini, Sze Y Ooi, Clemens von Birgelen, Allan S Jaffe, Kristian Thygesen, Gilles Montalescot, Heerajnarain Bulluck, Derek J Hausenloy

Institut for Klinisk Medicin - Hjertesygdomme

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

87 Citationer (Scopus)

Abstract

AIMS: The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated.

METHODS AND RESULTS: We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84-1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32-3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by the Fourth UDMI occurred in 12.7% of patients and was strongly associated with 1-year mortality [adj OR 3.21, 95% CI (1.42-7.27), P = 0.005]. We also present our results according to the type of troponin used (hs-cTn or conventional troponin).

CONCLUSION: Our analysis has demonstrated that in CCS patients with normal baseline cTn levels, the post-PCI cTn elevation of ≥5 × 99th percentile URL used to define Type 4a MI is associated with 1-year mortality and could be used to detect 'major' procedural myocardial injury in the absence of procedural complications or evidence of new myocardial ischaemia.

Originalsprog	Engelsk
Tidsskrift	European Heart Journal
Vol/bind	42
Nummer	4
Sider (fra-til)	323-334
Antal sider	12
ISSN	0195-668X
DOI	https://doi.org/10.1093/eurheartj/ehaa885
Status	Udgivet - jan. 2021

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10.1093/eurheartj/ehaa885

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850039/pdf/ehaa885.pdf

Citationsformater

Silvain, J., Zeitouni, M., Paradies, V., Zheng, H. L., Ndrepepa, G., Cavallini, C., Feldman, D. N., Sharma, S. K., Mehilli, J., Gili, S., Barbato, E., Tarantini, G., Ooi, S. Y., von Birgelen, C., Jaffe, A. S., Thygesen, K., Montalescot, G., Bulluck, H., & Hausenloy, D. J. (2021). Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data. European Heart Journal, 42(4), 323-334. https://doi.org/10.1093/eurheartj/ehaa885

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title = "Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data",

abstract = "AIMS: The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated.METHODS AND RESULTS: We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84-1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32-3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by the Fourth UDMI occurred in 12.7% of patients and was strongly associated with 1-year mortality [adj OR 3.21, 95% CI (1.42-7.27), P = 0.005]. We also present our results according to the type of troponin used (hs-cTn or conventional troponin).CONCLUSION: Our analysis has demonstrated that in CCS patients with normal baseline cTn levels, the post-PCI cTn elevation of ≥5 × 99th percentile URL used to define Type 4a MI is associated with 1-year mortality and could be used to detect 'major' procedural myocardial injury in the absence of procedural complications or evidence of new myocardial ischaemia.",

keywords = "Elective PCI, Myocardial infarction, Myocardial injury, Procedural complication, Procedural myocardial infarction, Procedural myocardial injury, NECROSIS, UNIVERSAL DEFINITION, ELEVATION, HIGH-SENSITIVITY TROPONIN, Percutaneous Coronary Intervention/adverse effects, Humans, Coronary Artery Disease, Myocardial Infarction, Troponin, Biomarkers",

author = "Johanne Silvain and Michel Zeitouni and Valeria Paradies and Zheng, {Huili L} and Gjin Ndrepepa and Claudio Cavallini and Feldman, {Dimitri N} and Sharma, {Samin K} and Julinda Mehilli and Sebastiano Gili and Emanuele Barbato and Giuseppe Tarantini and Ooi, {Sze Y} and {von Birgelen}, Clemens and Jaffe, {Allan S} and Kristian Thygesen and Gilles Montalescot and Heerajnarain Bulluck and Hausenloy, {Derek J}",

year = "2021",

month = jan,

doi = "10.1093/eurheartj/ehaa885",

language = "English",

volume = "42",

pages = "323--334",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "4",

}

Silvain, J, Zeitouni, M, Paradies, V, Zheng, HL, Ndrepepa, G, Cavallini, C, Feldman, DN, Sharma, SK, Mehilli, J, Gili, S, Barbato, E, Tarantini, G, Ooi, SY, von Birgelen, C, Jaffe, AS, Thygesen, K, Montalescot, G, Bulluck, H & Hausenloy, DJ 2021, 'Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data', European Heart Journal, bind 42, nr. 4, s. 323-334. https://doi.org/10.1093/eurheartj/ehaa885

Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data. / Silvain, Johanne; Zeitouni, Michel; Paradies, Valeria et al.
I: European Heart Journal, Bind 42, Nr. 4, 01.2021, s. 323-334.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI

T2 - a pooled analysis of patient-level data

AU - Silvain, Johanne

AU - Zeitouni, Michel

AU - Paradies, Valeria

AU - Zheng, Huili L

AU - Ndrepepa, Gjin

AU - Cavallini, Claudio

AU - Feldman, Dimitri N

AU - Sharma, Samin K

AU - Mehilli, Julinda

AU - Gili, Sebastiano

AU - Barbato, Emanuele

AU - Tarantini, Giuseppe

AU - Ooi, Sze Y

AU - von Birgelen, Clemens

AU - Jaffe, Allan S

AU - Thygesen, Kristian

AU - Montalescot, Gilles

AU - Bulluck, Heerajnarain

AU - Hausenloy, Derek J

PY - 2021/1

Y1 - 2021/1

N2 - AIMS: The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated.METHODS AND RESULTS: We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84-1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32-3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by the Fourth UDMI occurred in 12.7% of patients and was strongly associated with 1-year mortality [adj OR 3.21, 95% CI (1.42-7.27), P = 0.005]. We also present our results according to the type of troponin used (hs-cTn or conventional troponin).CONCLUSION: Our analysis has demonstrated that in CCS patients with normal baseline cTn levels, the post-PCI cTn elevation of ≥5 × 99th percentile URL used to define Type 4a MI is associated with 1-year mortality and could be used to detect 'major' procedural myocardial injury in the absence of procedural complications or evidence of new myocardial ischaemia.

AB - AIMS: The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated.METHODS AND RESULTS: We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84-1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32-3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by the Fourth UDMI occurred in 12.7% of patients and was strongly associated with 1-year mortality [adj OR 3.21, 95% CI (1.42-7.27), P = 0.005]. We also present our results according to the type of troponin used (hs-cTn or conventional troponin).CONCLUSION: Our analysis has demonstrated that in CCS patients with normal baseline cTn levels, the post-PCI cTn elevation of ≥5 × 99th percentile URL used to define Type 4a MI is associated with 1-year mortality and could be used to detect 'major' procedural myocardial injury in the absence of procedural complications or evidence of new myocardial ischaemia.

KW - Elective PCI

KW - Myocardial infarction

KW - Myocardial injury

KW - Procedural complication

KW - Procedural myocardial infarction

KW - Procedural myocardial injury

KW - NECROSIS

KW - UNIVERSAL DEFINITION

KW - ELEVATION

KW - HIGH-SENSITIVITY TROPONIN

KW - Percutaneous Coronary Intervention/adverse effects

KW - Humans

KW - Coronary Artery Disease

KW - Myocardial Infarction

KW - Troponin

KW - Biomarkers

U2 - 10.1093/eurheartj/ehaa885

DO - 10.1093/eurheartj/ehaa885

M3 - Journal article

C2 - 33257958

SN - 0195-668X

VL - 42

SP - 323

EP - 334

JO - European Heart Journal

JF - European Heart Journal

IS - 4

ER -

Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data

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