Key result
ARC-2-defined periprocedural MI is linked to ~3.9-fold higher 1-year cardiac mortality.
Why the study?
Definitions of periprocedural MI differ in biomarker thresholds and ischemia criteria and lack validation in patients with chronic coronary syndrome undergoing PCI.
Do ARC-2 and SCAI definitions of periprocedural MI have stronger prognostic relevance for cardiac death compared to UDMI definitions in patients with CCS undergoing PCI?
Cohort (n=4,404)
Do ARC-2 and SCAI definitions of periprocedural MI have stronger prognostic relevance for cardiac death compared to UDMI definitions in patients with CCS undergoing PCI?
Hazard Ratio: 3.9 (95% CI 1.54–9.93)
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Among chronic coronary syndrome patients undergoing PCI, the frequency and prognostic value of periprocedural MI varies considerably based on definitions. Periprocedural MI defined by the ARC-2 and SCAI occurred 3-6 times less frequently and were prognostically more relevant as compared with the UDMI. Clinically relevant definitions should be used in daily practice and clinical trials.”
“For a definition of periprocedural myocardial infarction to have clinical utility, it must be associated with prognosis (principally mortality); otherwise, there is little purpose beyond inflating event rates to increase statistical power in clinical trials.”
“This is a very interesting study for understanding the weight of each periprocedural MI definition in determining cardiac death at 1-year follow-up. There is always a debate within the interventional cardiology community on how to define a periprocedural MI and there are indeed many definitions that are differently used in various studies. This study shows that the incidence of periprocedural MI may vary much according to the definition used and that its relationship with cardiac death at 1-year is very wide. Periprocedural MI defined according to the 3rd UDMI definition is for example very frequent (up to 18%), but contributes a little to the risk of cardiac death at 1-year. On the contrary, periprocedural MI defined according to SCAI criteria has an incidence of 2%, but contributes a lot to the risk of developing a cardiac death at 1-year. These considerations are important to take in mind either in trial design or in daily clinical practice. In the latter periprocedural MIs are rarely diagnosed, but given the result of the present study, it may be of renewed interest to look at them, given their close relationship with 1-year cardiac death.”
ARC-2 and SCAI criteria for periprocedural MI are 7 to 9 times less frequent than UDMI criteria but are significantly stronger predictors of 1-year cardiac mortality following PCI in chronic coronary syndromes.
BACKGROUND Definitions of periprocedural myocardial infarction (MI) differ with respect to biomarker threshold as well as ancillary criteria for myocardial ischemia and are limited in terms of validation. OBJECTIVES This study evaluated the frequency and impact of periprocedural MI by using various MI definitions among patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI). METHODS Between 2010 and 2018, periprocedural MIs were assessed according to the third and fourth Universal Definition of Myocardial Infarction (UDMI), Academic Research Consortium-2 (ARC-2), and Society for Cardiovascular Angiography and Interventions (SCAI) criteria based on high-sensitivity troponin in patients with CCS undergoing PCI enrolled into the Bern PCI registry. The primary endpoint was cardiac death at 1 year. RESULTS Among 4,404 patients with CCS, periprocedural MI defined by the third UDMI, fourth UDMI, ARC-2, and SCAI were observed in 18.0%, 14.9%, 2.0%, and 2.0% of patients, respectively. Among patients with periprocedural MI defined by the third UDMI, fourth UDMI, ARC-2, and SCAI, cardiac mortality at 1 year was 2.9%, 3.0%, 5.8%, and 10.0%. The ARC-2 (HR: 3.90; 95% CI: 1.54-9.93) and SCAI (HR: 7.66; 95% CI: 3.64-16.11) were more relevant compared with the third UDMI (HR: 1.76; 95% CI: 1.04-3.00) and fourth UDMI (HR: 1.93; 95% CI: 1.11-3.37) for cardiac death at 1 year. CONCLUSIONS Among patients with CCS undergoing PCI, periprocedural MI defined according to the ARC-2 and SCAI criteria was 7 to 9 times less frequent compared with the third and fourth UDMI. Periprocedural MI defined by using the ARC-2 and SCAI were more prognostic for cardiac death at 1 year compared with the third and fourth UDMI. (CARDIOBASE Bern PCI Registry; NCT02241291).
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Ueki et al. (2022) conducted a cohort in Chronic coronary syndrome (CCS) (n=4,404). Periprocedural MI defined by ARC-2 and SCAI criteria vs. Third and fourth Universal Definition of Myocardial Infarction (UDMI) was evaluated on Cardiac death at 1 year (HR 3.90, 95% CI 1.54-9.93). Periprocedural MI defined by ARC-2 (HR 3.90) and SCAI (HR 7.66) criteria were 7 to 9 times less frequent but more prognostic for 1-year cardiac death than 3rd and 4th UDMI definitions.
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