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Observational Study
. 2025 May;18(5):e014934.
doi: 10.1161/CIRCINTERVENTIONS.124.014934. Epub 2025 Mar 31.

Periprocedural Myocardial Injury Using CKMB Following Elective PCI: Incidence and Associations With Long-Term Mortality

Nina Talmor  1 , Claire Graves  2 , Sam Kozloff  3 , Vincent J Major  4 , Yuhe Xia  4 , Binita Shah  1   5 , Anvar Babaev  1 , Louai Razzouk  1 , Sunil V Rao  1 , Michael J Attubato  1 , Frederick Feit  1 , James Slater  1 , Nathaniel R Smilowitz  1   5
Affiliations
Observational Study

Periprocedural Myocardial Injury Using CKMB Following Elective PCI: Incidence and Associations With Long-Term Mortality

Nina Talmor et al. Circ Cardiovasc Interv. 2025 May.

Abstract

Background: Myocardial injury detected after percutaneous coronary intervention (PCI) is associated with increased mortality. Predictors of post-PCI myocardial injury are not well established. The long-term prognostic relevance of post-PCI myocardial injury remains uncertain.

Methods: Consecutive adults aged ≥18 years with stable ischemic heart disease who underwent elective PCI at NYU Langone Health between 2011 and 2020 were included in a retrospective, observational study. Patients with acute myocardial infarction or creatinine kinase myocardial band (CKMB) or troponin concentrations >99% of the upper reference limit before PCI were excluded. All patients had routine measurement of CKMB concentrations at 1 and 3 hours post-PCI. Post-PCI myocardial injury was defined as a peak CKMB concentration >99% upper reference limit. Linear regression models were used to identify clinical factors associated with post-PCI myocardial injury. Cox proportional hazard models were generated to evaluate relationships between post-PCI myocardial injury and all-cause mortality at long-term follow-up.

Results: Among 10 807 patients undergoing elective PCI, the median age was 67 years (interquartile range, 15.6), and 24.9% were of female sex. Post-PCI myocardial injury occurred in 1813 (16.8%) patients. Myocardial injury was less common among female than male patients (14.1% versus 17.7%, P<0.001). Older age, longer lesion lengths, multivessel PCI, severe coronary calcification, and thrombectomy device use were independently associated with post-PCI myocardial injury with CKMB levels ≥99% upper reference limit. Over 46 071 patient-years of follow-up (mean 4.3 years), 472 patients died (4.4%). A greater proportion of patients with versus without post-PCI myocardial injury died during follow-up (7.9% versus 3.6%, P<0.001). After adjustment for demographics and clinical covariates, post-PCI myocardial injury was associated with an excess hazard for long-term mortality (hazard ratio, 1.46 [95% CI, 1.20-1.78]).

Conclusions: Myocardial injury defined by elevated CKMB early after PCI is common and associated with all-cause, long-term mortality. More complex coronary anatomy is predictive of post-PCI myocardial injury.

Keywords: cardiac catheterization; creatine kinase, MB form; mortality; myocardial infarction; percutaneous coronary intervention; prognosis.

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Conflict of interest statement

Dr Smilowitz serves as a consultant to Abbott Vascular and Boston Scientific. Dr Shah serves on the advisory board for Philips Volcano and Novo Nordisk; serves on the steering committee for the Elevate Pivotal Study sponsored by Magenta Medical; and serves on the Data Safety Monitoring Board for the EnCompass trial sponsored by Insight Medical. The other authors report no conflicts.

References

    1. Tricoci P, Leonardi S, White J, White HD, Armstrong PW, Montalescot G, Giugliano RP, Gibson CM, Van de Werf F, Califf RM, et al. Cardiac troponin after percutaneous coronary intervention and 1-year mortality in non-ST-segment elevation acute coronary syndrome using systematic evaluation of biomarker trends. J Am Coll Cardiol. 2013;62:242–251. doi: 10.1016/j.jacc.2013.04.043 - DOI - PubMed
    1. Park DW, Kim YH, Yun SC, Ahn JM, Lee JY, Kim WJ, Kang SJ, Lee SW, Lee CW, Park SW, et al. Frequency, causes, predictors, and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention. Eur Heart J. 2013;34:1662–1669. doi: 10.1093/eurheartj/eht048 - DOI - PubMed
    1. Stone GW, Kappetein AP, Sabik JF, Pocock SJ, Morice MC, Puskas J, Kandzari DE, Karmpaliotis D, Brown WM, Lembo NJ, et al. Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease. N Engl J Med. 2019;381:1820–1830. doi: 10.1056/NEJMoa1909406 - DOI - PubMed
    1. Fearon WF, Zimmermann FM, De Bruyne B, Piroth Z, van Straten AHM, Szekely L, Davidavičius G, Kalinauskas G, Mansour S, Kharbanda R, et al. Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. N Engl J Med. 2022;386:128–137. doi: 10.1056/NEJMoa2112299 - DOI - PubMed
    1. Seto AH. Does “Myocardial Injury” Matter Post-PCI? JACC Cardiovasc Interv. 2019;12:1963–1965. doi: 10.1016/j.jcin.2019.07.047 - DOI - PubMed

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