Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention: a pooled analysis of patient-level data

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Johanne Silvain, Univ Paris 1 Pantheon Sorbonne, heSam Universite, Universite Pantheon-Sorbonne
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  • Michel Zeitouni, Univ Paris 1 Pantheon Sorbonne, heSam Universite, Universite Pantheon-Sorbonne
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  • Valeria Paradies, Maasstad Hospital
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  • Huili L Zheng, Health Promotion Board
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  • Gjin Ndrepepa, Department of Adult Congenital Cardiology, Bart's Heart Centre, Bart's Health NHS Trust, London, UK.
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  • Claudio Cavallini, Division of Cardiology
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  • Dimitri N Feldman, Weill Cornell Med Qatar, Weill Cornell Medical College Qatar
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  • Samin K Sharma, The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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  • Julinda Mehilli, Ludwig Maximilians University Munich, Ludwig Maximilians University Munich, University Hospital Munich, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Munich, Germany.
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  • Sebastiano Gili, Centro Cardiologico Monzino, Milan
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  • Emanuele Barbato, Univ Naples Federico II, University of Naples Federico II, Dept Neurosci Reprod & Odontostomatol Sci
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  • Giuseppe Tarantini, University of Padua Medical School
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  • Sze Y Ooi, Prince Wales Hosp, Prince of Wales Hospital, Chinese University of Hong Kong, Dept Surg
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  • Clemens von Birgelen, Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany; Department of Cardiology, Swedish Medical Center, Seattle, Washington.
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  • Allan S Jaffe, Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany; Department of Cardiology, Swedish Medical Center, Seattle, Washington.
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  • Kristian Thygesen
  • Gilles Montalescot, Univ Paris 1 Pantheon Sorbonne, heSam Universite, Universite Pantheon-Sorbonne
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  • Heerajnarain Bulluck, Norwich Medical School University of East Anglia and Norfolk and Norwich University Hospital, Norwich, UK.
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  • Derek J Hausenloy, Univ Coll London Hosp NHS Fdn Trust, University College London Hospitals NHS Foundation Trust, University of London, University College London, Inst Nucl Med

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.

Original languageEnglish
JournalEuropean Heart Journal
Volume42
Issue4
ISSN0195-668X
DOIs
Publication statusPublished - Jan 2021

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