Peri-procedural myocardial infarction following PCI occurred in 7.1% of patients and was independently associated with an increased risk of mortality (adjusted HR 1.20; 95% CI 1.04-1.39).
Meta-Analysis (n=23,604)
Yes
Is peri-procedural MI associated with increased mortality in patients undergoing PCI?
Peri-procedural MI occurs in approximately 7% of PCI procedures, is frequently caused by side-branch occlusion, and is independently associated with a 20% increased risk of long-term mortality.
Effect estimate: HR 1.20 (95% CI 1.04-1.39)
AIMS: Peri-procedural myocardial infarction (MI) is a not infrequent complication of percutaneous coronary intervention (PCI), but conflicting information exists regarding incidence and prognostic impact of this event. We investigated frequency, causes, predictors, and clinical relevance of peri-procedural MI, using a large database. METHODS AND RESULTS: We pooled individual patient-level data from 11 PCI studies in which peri-procedural creatine kinase-MB mass was routinely measured and mortality data were prospectively collected. Among 23 604 patients from 11 studies, 1677 7. 1% 95% confidence interval (CI) 6. 8-7. 5% had peri-procedural MI. The most common mechanism of peri-procedural MI was side-branch occlusion. Independent predictors of peri-procedural MI were older age, female gender, diabetes, hypertension, renal dysfunction, multivessel disease, left anterior descending artery disease, left main disease, bifurcation lesion, long lesion, drug-eluting stents, and number of stents. Follow-up varied from 1 year to 5 years. In a crude analysis, patients with peri-procedural MI had significantly a higher risk of mortality than those without peri-procedural MI hazard ratio (HR) 1. 47; 95% CI 1. 24-1. 74. After adjustment for baseline covariates, peri-procedural MI was associated with an increased risk of mortality (HR 1. 20; 95% CI 1. 04-1. 39). CONCLUSION: Among patients undergoing PCI, the occurrence of peri-procedural MI measured by CK-MB mass assay was ~7%, and more than half of cases were associated with side-branch occlusion. Several higher risk patients, lesions, and procedural characteristics were independent predictors of peri-procedural MI. Peri-procedural MI was associated with an increase in mortality.
Park et al. (Tue,) conducted a meta-analysis in Percutaneous coronary intervention (n=23,604). Peri-procedural myocardial infarction vs. No peri-procedural myocardial infarction was evaluated on Mortality (HR 1.20, 95% CI 1.04-1.39). Peri-procedural myocardial infarction following PCI occurred in 7.1% of patients and was independently associated with an increased risk of mortality (adjusted HR 1.20; 95% CI 1.04-1.39).