Varying definitions for periprocedural myocardial infarction alter event rates and prognostic implications

Abstract

Background: Periprocedural 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 results: The 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.

Conclusion: In 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.

Keywords: percutaneous coronary intervention; periprocedural myocardial infarction; reinfarction; troponin T.

Figure 1.

Study population. The diagram shows the patients from the total angioplasty cohort. Also, the reasons for exclusion from the current study for those who underwent PCI in the study period are shown. *Fifty‐two patients had post‐PCI TnT >5×URL. CHD indicates coronary heart disease; MI, myocardial infarction; NSTEACS, non‐ST‐segment elevation acute coronary syndrome; PCI, percutaneous coronary intervention; PMI, periprocedural myocardial infarction; SCAI, Society for Cardiovascular Angiography and Interventions; STEMI, ST‐segment elevation myocardial infarction; TnT, troponin T; URL, upper reference limit.

Figure 2.

Additional criteria for periprocedural myocardial infarction according to the 2012 universal MI definition. MI indicates myocardial infarction.

Figure 3.

Death/MI rate at 2 years based on the 2007 and 2012 universal MI definitions and SCAI definition. Kaplan‐Meier's analysis P values are reported for comparisons PMI versus no PMI. MI indicates myocardial infarction; PMI, periprocedural myocardial infarction; SCAI, Society for Cardiovascular Angiography and Interventions.

Figure 4.

Kaplan‐Meier's curve for death, MI, and combined death and MI. Actuarial outcomes for 690 patients are shown. Five patients who had unsuccessful PCI as a result of failure to recanalize chronic total occlusion and 47 (6.3%) had <30 days follow‐up; those patients were not included in late Kaplan‐Meier's analysis. MI indicates myocardial infarction; PCI, percutaneous coronary intervention; PMI, periprocedural myocardial infarction; SCAI, Society for Cardiovascular Angiography and Interventions.