Key result
The UDMI-3/4 criteria defined periprocedural myocardial infarction with a lower prevalence (3.2% vs 17.5%) but a stronger prognostic impact on mortality (HR 2.54 vs 1.60) compared to SCAI criteria.
Why the study?
Several contradictory definitions have been proposed for diagnosing periprocedural myocardial infarction after CABG, leaving its true prevalence and optimal prognostic definition unclear.
Does the UDMI-3/4 definition of PMI have a more relevant prognostic impact for all-cause mortality compared to the SCAI definition in patients undergoing CABG?
Meta-Analysis (n=21,203)
Does the UDMI-3/4 definition of PMI have a more relevant prognostic impact for all-cause mortality compared to the SCAI definition in patients undergoing CABG?
Effect estimate: HR 2.54 (95% CI 1.62-4.00)
Absolute Event Rate: 3.2% vs 17.5%
p-value: p=0.097
The UDMI criteria for periprocedural myocardial infarction identify a smaller proportion of CABG patients but with a more significant prognostic impact on mortality compared to SCAI criteria.
AIMS: Several contradictory definitions have been proposed for the diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass grafting (CABG). The aim of this study was to assess the prevalence of PMI and to identify the definition of PMI with the most relevant prognostic impact. METHODS AND RESULTS: In this systematic review and meta-analysis, the search was conducted in thee electronic databases (MEDLINE & PubMed Central, Cochrane Library, Embase). The primary definitions of interest comprised the universal definition of myocardial infarction (UDMI; UDMI-3/4) and Society for Cardiovascular Angiography and Interventions (SCAI) definition. The primary outcomes were the prevalence of PMI and its prognostic impact, expressed in hazard ratios (HRs) and 95% confidence intervals (CIs). The frequentist framework was employed for the primary analysis, and a secondary analysis was performed under a Bayesian framework. Ten studies were included (n = 21 203 patients). The prevalence of PMI was 17.5% (95%CI 9.5-29.8%) according to SCAI, and 3.2% (95%CI 1.6-6.2%) according to UDMI-3/4. The pooled HR of the SCAI definition for freedom from all-cause mortality was 1.60 (95%CI 1.18-2.16) and the HR was 2.54 (1.62-4.00) for UDMI-3/4 (P-for-interaction = 0.097). The posterior probability of exceeding an HR of 1 was >99% for both definitions, while the probability of the UDMI-3/4 exceeding the mean HR of SCAI was 96.4%. The results were robust across sensitivity analyses. CONCLUSION: The prevalence of PMI is markedly higher when diagnosed according to SCAI criteria in CABG patients. The UDMI criteria define PMI with the most relevant prognostic impact in CABG patients.
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Swinnen et al. (2025) conducted a meta-analysis in Periprocedural myocardial infarction after coronary artery bypass grafting (n=21,203). Universal definition of myocardial infarction (UDMI-3/4) vs. Society for Cardiovascular Angiography and Interventions (SCAI) definition was evaluated on Prevalence of PMI and its prognostic impact on all-cause mortality (HR 2.54, 95% CI 1.62-4.00, p=0.097). The UDMI-3/4 criteria defined periprocedural myocardial infarction with a lower prevalence (3.2% vs 17.5%) but a stronger prognostic impact on mortality (HR 2.54 vs 1.60) compared to SCAI criteria.
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