Impact of multi-vessel therapy to the risk of periprocedural myocardial injury after elective coronary intervention: exploratory study

Abstract

BackgroundsPeriprocedural myocardial injury (PMI) after elective percutaneous coronary intervention (PCI) significantly influences the prognosis of coronary artery disease (CAD). However, it was unclear whether the occurrence of PMI was associated with a series of controllable factors, such as PCI strategy or severity of CAD.MethodsA total of 544 consecutive stable CAD patients underwent elective PCI were enrolled. The main outcome is PMI, defined as troponin T after PCI was at least one value above the 99th percentile upper reference limit. Major adverse cardiac events (MACE), including all-cause death, repeat myocardial infarction and target vessel revascularization were record in the period of follow-up. Univariate and multivariate analysis was applied to assess predictors for the occurrence of PMI.ResultsThe incidence of PMI was 38.8% in the study. Compared with non-PMI patients (n = 333), PMI patients (n = 211) had more diseased vessels, higher Gensini and Syntax score. Meanwhile, there were higher incidence of MACE in PMI groups (9.5% vs. 3.2%, P < 0.01). We found that PMI patients underwent higher proportion of multi-vessel PCI simultaneously (32.2% vs. 10.5%, P < 0.01) and had more stents implanted (1.8 ± 0.8 vs. 1.4 ± 0.6, P < 0.01). Importantly, after simultaneously adjusted by other factors (such as age, diabetes, total cholesterol, number of diseased vessels, Gensini score and stent length), the risk of PMI was still increased 84% by multi-vessel PCI independently (OR = 1.654, 95% CI = 1.004–2.720, P < 0.05).ConclusionsThe phenomenon of PMI occurred more commonly in stable CAD patients underwent multi-vessel PCI. Multi-vessel international therapy could increase the risk of PMI in elective PCI.

Clinical Predictors of Risk for Decreased Cardiac Tissue Perfusion After Percutaneous Coronary Intervention: A Retrospective Cohort Study

“…To the best of our knowledge, this is the first cohort study investigating the predictors of DCTP. The prevalence of DCTP during a 7‐year period was found to be 12.1%, which coincides with the prevalence range of PMI worldwide (Arai et al., ; Chen et al., ; Christensen et al., ; Idris et al., ; Mäkikallio et al., ; Prasad & Herrmann, ; Tsabedze et al., ; Wessler et al., ; Yamaji et al., ). However, the interpretation of this information must be done with caution, considering the several definitions on PMI used by different studies.…”

“…After PCI, an elevation of cardiac biomarkers above three times their basal values is expected (CathPCI Registry, ). However, periprocedural myocardial infarction (PMI) after PCI, remains a common complication in 2.6–38.8% of cases worldwide (Arai et al., ; Chen et al., ; http://Christensen, http://Huang, http://Torp-Pedersen, http://Trydal, & http://Ravkilde, ; Idris et al., ; Mäkikallio et al., ; Prasad & Herrmann, ; Tsabedze et al., ; Wessler et al., ; Yamaji et al., ).…”

Pre‐loading therapy with statins in patients with angina and acute coronary syndromes undergoing PCI

“…Over the past two decades, technical advances in PCI have resulted in a better and safer therapeutic procedure with minimal procedural complications. However, about 38.8% of patients undergoing elective PCI, sustain myocardial injury arising from the procedure itself, the extent of which is significant enough to alter prognosis and is also associated with increased subsequent mortality . A major complication of PCI is PCI‐related myocardial infarction (MI) .…”

Association of SYNTAX score with myocardial injury in STEMI patients: a cardiac magnetic resonance study

“…However, there was no direct relationship among them were stated. In another several studies [10,11,15,16], in patients undergone CABG or PCI, SS was not only positively related to peri-procedural myocardial injury (deprived by elevated cardiac troponin and CKMB 6h after operation), but also an independent predictor of it. The increase in release of cardiac biomarkers after selective PCI was signi cantly associated with the extent of atherosclerosis identi ed by the SS [17].…”