Impact of Peri-Procedural Myocardial Infarction on Outcomes After Revascularization
Numerous definitions for peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) surgery exist. The purpose of this study was to investigate the PMI rates according to various definitions, their clinically relevant associatio...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2020-10, Vol.76 (14), p.1622-1639 |
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| creator | Hara, Hironori Serruys, Patrick W. Takahashi, Kuniaki Kawashima, Hideyuki Ono, Masafumi Gao, Chao Wang, Rutao Mohr, Friedrich W. Holmes, David R. Davierwala, Piroze M. Head, Stuart J. Thuijs, Daniel J.F.M. Milojevic, Milan Kappetein, Arie Pieter Garg, Scot Onuma, Yoshinobu Mack, Michael J. |
| description | Numerous definitions for peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) surgery exist.
The purpose of this study was to investigate the PMI rates according to various definitions, their clinically relevant association with all-cause mortality at 10 years, and their impact on composite endpoints at 5 years in the SYNTAXES (Synergy between PCI with Taxus and Cardiac Surgery Extended Survival) trial.
PMI was classified as a myocardial infarction occurring within 48 h of the procedure according to definitions of the SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries), ISCHEMIA (International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches), and EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials; the Fourth Universal Definition of MI; and the Society for Cardiovascular Angiography and Interventions (SCAI). Of the 1,800 patients enrolled, 1,652 with creatine kinase and/or creatine kinase-myocardial band (CK-MB) post-procedure were included. The association between PMI and mortality was analyzed by Cox regression.
PMI rates according to the SYNTAX and Fourth Universal Definition of MI, both of which required CK-MB elevation and electrocardiographic evidence of permanent myocardial damage, were 2.7% and 3.0%, respectively, in the PCI arm versus 2.4% and 2.1%, respectively, in the CABG arm. PMI rates according to the SCAI or EXCEL definition were higher in the PCI (5.7%) and CABG (16.5%) arms. PMIs according to the SYNTAX and Fourth Universal Definition of MI were more strongly associated with mortality than EXCEL and SCAI PMIs defined by isolated enzyme elevation when CK-MB was more than 10 times ULN. The impact of these “enzyme-driven events” on time-to-event curves and the composite endpoints was greater in the surgical cohort. PMIs after PCI were associated with 10-year mortality regardless of definition, whereas their impact on mortality after CABG was limited to 1 year.
The rates of PMI are highly dependent on their definition, which affects time-to-event curves, composite endpoints, and their lethal prognostic relevance. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment o |
| doi_str_mv | 10.1016/j.jacc.2020.08.009 |
| format | Article |
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The purpose of this study was to investigate the PMI rates according to various definitions, their clinically relevant association with all-cause mortality at 10 years, and their impact on composite endpoints at 5 years in the SYNTAXES (Synergy between PCI with Taxus and Cardiac Surgery Extended Survival) trial.
PMI was classified as a myocardial infarction occurring within 48 h of the procedure according to definitions of the SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries), ISCHEMIA (International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches), and EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials; the Fourth Universal Definition of MI; and the Society for Cardiovascular Angiography and Interventions (SCAI). Of the 1,800 patients enrolled, 1,652 with creatine kinase and/or creatine kinase-myocardial band (CK-MB) post-procedure were included. The association between PMI and mortality was analyzed by Cox regression.
PMI rates according to the SYNTAX and Fourth Universal Definition of MI, both of which required CK-MB elevation and electrocardiographic evidence of permanent myocardial damage, were 2.7% and 3.0%, respectively, in the PCI arm versus 2.4% and 2.1%, respectively, in the CABG arm. PMI rates according to the SCAI or EXCEL definition were higher in the PCI (5.7%) and CABG (16.5%) arms. PMIs according to the SYNTAX and Fourth Universal Definition of MI were more strongly associated with mortality than EXCEL and SCAI PMIs defined by isolated enzyme elevation when CK-MB was more than 10 times ULN. The impact of these “enzyme-driven events” on time-to-event curves and the composite endpoints was greater in the surgical cohort. PMIs after PCI were associated with 10-year mortality regardless of definition, whereas their impact on mortality after CABG was limited to 1 year.
The rates of PMI are highly dependent on their definition, which affects time-to-event curves, composite endpoints, and their lethal prognostic relevance. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)
[Display omitted]</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2020.08.009</identifier><identifier>PMID: 33004127</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>CABG ; Coronary Artery Bypass - adverse effects ; Coronary Artery Bypass - mortality ; Coronary Artery Bypass - trends ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - mortality ; Coronary Artery Disease - surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Mortality - trends ; Myocardial Infarction - diagnosis ; Myocardial Infarction - etiology ; Myocardial Infarction - mortality ; PCI ; Percutaneous Coronary Intervention - adverse effects ; Percutaneous Coronary Intervention - mortality ; Percutaneous Coronary Intervention - trends ; peri-procedural myocardial infarction ; Postoperative Complications - diagnosis ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; SYNTAX ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 2020-10, Vol.76 (14), p.1622-1639</ispartof><rights>2020 American College of Cardiology Foundation</rights><rights>Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-30201aa98934cc8816d3104f39e3fcd1860f230fa8dc8f835796073fec3893433</citedby><cites>FETCH-LOGICAL-c422t-30201aa98934cc8816d3104f39e3fcd1860f230fa8dc8f835796073fec3893433</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109720362410$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33004127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hara, Hironori</creatorcontrib><creatorcontrib>Serruys, Patrick W.</creatorcontrib><creatorcontrib>Takahashi, Kuniaki</creatorcontrib><creatorcontrib>Kawashima, Hideyuki</creatorcontrib><creatorcontrib>Ono, Masafumi</creatorcontrib><creatorcontrib>Gao, Chao</creatorcontrib><creatorcontrib>Wang, Rutao</creatorcontrib><creatorcontrib>Mohr, Friedrich W.</creatorcontrib><creatorcontrib>Holmes, David R.</creatorcontrib><creatorcontrib>Davierwala, Piroze M.</creatorcontrib><creatorcontrib>Head, Stuart J.</creatorcontrib><creatorcontrib>Thuijs, Daniel J.F.M.</creatorcontrib><creatorcontrib>Milojevic, Milan</creatorcontrib><creatorcontrib>Kappetein, Arie Pieter</creatorcontrib><creatorcontrib>Garg, Scot</creatorcontrib><creatorcontrib>Onuma, Yoshinobu</creatorcontrib><creatorcontrib>Mack, Michael J.</creatorcontrib><creatorcontrib>SYNTAX Extended Survival Investigators</creatorcontrib><title>Impact of Peri-Procedural Myocardial Infarction on Outcomes After Revascularization</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Numerous definitions for peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) surgery exist.
The purpose of this study was to investigate the PMI rates according to various definitions, their clinically relevant association with all-cause mortality at 10 years, and their impact on composite endpoints at 5 years in the SYNTAXES (Synergy between PCI with Taxus and Cardiac Surgery Extended Survival) trial.
PMI was classified as a myocardial infarction occurring within 48 h of the procedure according to definitions of the SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries), ISCHEMIA (International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches), and EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials; the Fourth Universal Definition of MI; and the Society for Cardiovascular Angiography and Interventions (SCAI). Of the 1,800 patients enrolled, 1,652 with creatine kinase and/or creatine kinase-myocardial band (CK-MB) post-procedure were included. The association between PMI and mortality was analyzed by Cox regression.
PMI rates according to the SYNTAX and Fourth Universal Definition of MI, both of which required CK-MB elevation and electrocardiographic evidence of permanent myocardial damage, were 2.7% and 3.0%, respectively, in the PCI arm versus 2.4% and 2.1%, respectively, in the CABG arm. PMI rates according to the SCAI or EXCEL definition were higher in the PCI (5.7%) and CABG (16.5%) arms. PMIs according to the SYNTAX and Fourth Universal Definition of MI were more strongly associated with mortality than EXCEL and SCAI PMIs defined by isolated enzyme elevation when CK-MB was more than 10 times ULN. The impact of these “enzyme-driven events” on time-to-event curves and the composite endpoints was greater in the surgical cohort. PMIs after PCI were associated with 10-year mortality regardless of definition, whereas their impact on mortality after CABG was limited to 1 year.
The rates of PMI are highly dependent on their definition, which affects time-to-event curves, composite endpoints, and their lethal prognostic relevance. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)
[Display omitted]</description><subject>CABG</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Bypass - mortality</subject><subject>Coronary Artery Bypass - trends</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Mortality - trends</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - etiology</subject><subject>Myocardial Infarction - mortality</subject><subject>PCI</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Percutaneous Coronary Intervention - trends</subject><subject>peri-procedural myocardial infarction</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>SYNTAX</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtKxTAQhoMoery8gAvp0k3rJOklBTciXg4oiug6xOkEcmhPjkkrHJ_GZ_HJbDnqUhiYzff_zHyMHXPIOPDybJEtDGImQEAGKgOot9iMF4VKZVFX22wGlSxSDnW1x_ZjXABAqXi9y_akBMi5qGbsZd6tDPaJt8kjBZc-Bo_UDMG0yf3aowmNM-3X53xpTcDe-WUyzsPQo-8oJhe2p_D1-UTvJuLQmuA-zAQdsh1r2khHP_uAvVxfPV_epncPN_PLi7sUcyH6VI6Xc2NqVcscUSleNpJDbmVN0mLDVQlWSLBGNaiskkVVl-NPllBOESkP2OmmdxX820Cx152LSG1rluSHqEWeq5znQk6o2KAYfIyBrF4F15mw1hz0pFMv9KRTTzo1KD3qHEMnP_3Da0fNX-TX3wicbwAav3x3FHRER8tRoQuEvW68-6__G_9ah0U</recordid><startdate>20201006</startdate><enddate>20201006</enddate><creator>Hara, Hironori</creator><creator>Serruys, Patrick W.</creator><creator>Takahashi, Kuniaki</creator><creator>Kawashima, Hideyuki</creator><creator>Ono, Masafumi</creator><creator>Gao, Chao</creator><creator>Wang, Rutao</creator><creator>Mohr, Friedrich W.</creator><creator>Holmes, David R.</creator><creator>Davierwala, Piroze M.</creator><creator>Head, Stuart J.</creator><creator>Thuijs, Daniel J.F.M.</creator><creator>Milojevic, Milan</creator><creator>Kappetein, Arie Pieter</creator><creator>Garg, Scot</creator><creator>Onuma, Yoshinobu</creator><creator>Mack, Michael J.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20201006</creationdate><title>Impact of Peri-Procedural Myocardial Infarction on Outcomes After Revascularization</title><author>Hara, Hironori ; 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The purpose of this study was to investigate the PMI rates according to various definitions, their clinically relevant association with all-cause mortality at 10 years, and their impact on composite endpoints at 5 years in the SYNTAXES (Synergy between PCI with Taxus and Cardiac Surgery Extended Survival) trial.
PMI was classified as a myocardial infarction occurring within 48 h of the procedure according to definitions of the SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries), ISCHEMIA (International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches), and EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials; the Fourth Universal Definition of MI; and the Society for Cardiovascular Angiography and Interventions (SCAI). Of the 1,800 patients enrolled, 1,652 with creatine kinase and/or creatine kinase-myocardial band (CK-MB) post-procedure were included. The association between PMI and mortality was analyzed by Cox regression.
PMI rates according to the SYNTAX and Fourth Universal Definition of MI, both of which required CK-MB elevation and electrocardiographic evidence of permanent myocardial damage, were 2.7% and 3.0%, respectively, in the PCI arm versus 2.4% and 2.1%, respectively, in the CABG arm. PMI rates according to the SCAI or EXCEL definition were higher in the PCI (5.7%) and CABG (16.5%) arms. PMIs according to the SYNTAX and Fourth Universal Definition of MI were more strongly associated with mortality than EXCEL and SCAI PMIs defined by isolated enzyme elevation when CK-MB was more than 10 times ULN. The impact of these “enzyme-driven events” on time-to-event curves and the composite endpoints was greater in the surgical cohort. PMIs after PCI were associated with 10-year mortality regardless of definition, whereas their impact on mortality after CABG was limited to 1 year.
The rates of PMI are highly dependent on their definition, which affects time-to-event curves, composite endpoints, and their lethal prognostic relevance. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972)
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33004127</pmid><doi>10.1016/j.jacc.2020.08.009</doi><tpages>18</tpages></addata></record> |
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| ispartof | Journal of the American College of Cardiology, 2020-10, Vol.76 (14), p.1622-1639 |
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| source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | CABG Coronary Artery Bypass - adverse effects Coronary Artery Bypass - mortality Coronary Artery Bypass - trends Coronary Artery Disease - diagnosis Coronary Artery Disease - mortality Coronary Artery Disease - surgery Female Follow-Up Studies Humans Male Mortality - trends Myocardial Infarction - diagnosis Myocardial Infarction - etiology Myocardial Infarction - mortality PCI Percutaneous Coronary Intervention - adverse effects Percutaneous Coronary Intervention - mortality Percutaneous Coronary Intervention - trends peri-procedural myocardial infarction Postoperative Complications - diagnosis Postoperative Complications - etiology Postoperative Complications - mortality SYNTAX Treatment Outcome |
| title | Impact of Peri-Procedural Myocardial Infarction on Outcomes After Revascularization |
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