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

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Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention : a pooled analysis of patient-level data. / Silvain, Johanne; Zeitouni, Michel; Paradies, Valeria; Zheng, Huili L; Ndrepepa, Gjin; Cavallini, Claudio; Feldman, Dimitri N; Sharma, Samin K; Mehilli, Julinda; Gili, Sebastiano; Barbato, Emanuele; Tarantini, Giuseppe; Ooi, Sze Y; von Birgelen, Clemens; Jaffe, Allan S; Thygesen, Kristian; Montalescot, Gilles; Bulluck, Heerajnarain; Hausenloy, Derek J.

In: European Heart Journal, Vol. 42, No. 4, 01.2021.

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

Harvard

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, 'Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention: a pooled analysis of patient-level data', European Heart Journal, vol. 42, no. 4. https://doi.org/10.1093/eurheartj/ehaa885

APA

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). Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention: a pooled analysis of patient-level data. European Heart Journal, 42(4). https://doi.org/10.1093/eurheartj/ehaa885

CBE

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. Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention: a pooled analysis of patient-level data. European Heart Journal. 42(4). https://doi.org/10.1093/eurheartj/ehaa885

MLA

Vancouver

Author

Silvain, Johanne ; Zeitouni, Michel ; Paradies, Valeria ; Zheng, Huili L ; Ndrepepa, Gjin ; Cavallini, Claudio ; Feldman, Dimitri N ; Sharma, Samin K ; Mehilli, Julinda ; Gili, Sebastiano ; Barbato, Emanuele ; Tarantini, Giuseppe ; Ooi, Sze Y ; von Birgelen, Clemens ; Jaffe, Allan S ; Thygesen, Kristian ; Montalescot, Gilles ; Bulluck, Heerajnarain ; Hausenloy, Derek J. / Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention : a pooled analysis of patient-level data. In: European Heart Journal. 2021 ; Vol. 42, No. 4.

Bibtex

@article{3dce2bb8d42b40298565a708d08717d6,
title = "Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention: 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.",
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}",
note = "Published on behalf of the European Society of Cardiology. All rights reserved. {\textcopyright} The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.",
year = "2021",
month = jan,
doi = "10.1093/eurheartj/ehaa885",
language = "English",
volume = "42",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "4",

}

RIS

TY - JOUR

T1 - Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention

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

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.

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.

U2 - 10.1093/eurheartj/ehaa885

DO - 10.1093/eurheartj/ehaa885

M3 - Journal article

C2 - 33257958

VL - 42

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 4

ER -