Incidence of periprocedural myocardial infarction and cardiac biomarker testing after percutaneous coronary intervention in Japan: results from a multicenter registry

Abstract

Periprocedural myocardial infarction (pMI) is an important complication associated with percutaneous coronary intervention (PCI). However, data on the frequency of biomarker testing and the incidence of pMI remain unclear. Using the multicenter Japan Cardiovascular Database, we identified 2182 patients who underwent PCI without preprocedural cardiac biomarker elevation (silent ischemia, stable angina, or unstable angina without biomarker elevation) from September 2008 to August 2011. Of these, 550 patients (25.2 %) underwent cardiac biomarker testing within 6-24 h after PCI. The incidence of pMI was 2.7 % among all identified patients and 7.5 % among those who underwent cardiac marker testing. Of note, cardiac biomarker testing was performed more frequently than no testing in patients with a higher risk profile such as unstable angina (32.7 vs 24.7 %, P < 0.001), higher symptom scaling (28.2 vs 22.5 %, P = 0.008), urgent or emergent procedures (19.3 vs 15.0 %, P = 0.022 or 4.2 vs 1.0 %, P < 0.001, respectively), and type C lesion (31.3 vs 25.2 %, P = 0.006). Presentation with silent ischemia (odds ratio = 1.51, 95 % confidence interval (CI) 1.16-1.97) and nonemergent PCIs (odds ratio = 3.45, 95 % CI 1.79-6.67) were associated with no postprocedural cardiac biomarker testing. The real-world multicenter PCI registry in Japan revealed an incidence of 2.7 % for pMI; however, cardiac biomarkers were assessed in only 25.2 % of patients after PCI. The results suggest an underuse of postprocedural biomarker testing and room for procedural quality improvement, particularly in cases of silent ischemia and nonemergent cases.

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., ).…”

Effect of estimated glomerular filtration rate on periprocedural myocardial infarction in patients undergoing elective percutaneous coronary intervention

“…1,11 The frequency of PMI was lower in some studies, which were not measured cardiac biomarkers in all patients after PCI. 12 We routinely measured cardiac biomarkers before, at 8, and at 24 hours after PCI.…”

Effect of High‐Dose Statin Pretreatment on the Incidence of Periprocedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention: Grading the Evidence Through a Cumulative Meta‐analysis

“…In the last few years, the number of patients undergoing PCI for coronary artery disease has been increasing rapidly, according to many medical reports from all over the world. However, many studies have demonstrated that periprocedural myocardial infarction (PMI) is a vital and frequent complication for patients undergoing PCI, which was assessed by quantitative measurement of myocardial enzymes and elevation of cardiac biomarkers such as troponins and creatine kinase‐myocardial band, leading to higher mortality during the perioperative period . Cardiologists have indicated that several factors affect the occurrence of PMI, including the formation of distal embolism, side‐branch occlusion, coronary artery dissection, disruption of collateral flow, inflammation, and mixed pathological mechanisms …”