TY - JOUR
T1 - Association of peri-procedural myocardial infarction with mortality after stenting true coronary bifurcation lesions
T2 - A pooled individual participant data analysis from four randomized controlled trials
AU - for DKCRUSH serial trials
AU - Sheiban, Imad
AU - Ge, Zhen
AU - Kan, Jing
AU - Nie, Shaoping
AU - Zhang, Jun Jie
AU - Santoso, Teguh
AU - Munawar, Muhammad
AU - Ye, Fei
AU - Han, Yaling
AU - Chen, Shao Liang
N1 - Funding Information:
Jiangsu Provincial Special Program of Medical Science, Grant/Award Number: BE2019615; Nanjing Health Science and Technology Development Special Fund Project, Grant/Award Number: ZKX20034 Funding information
Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2021
Y1 - 2021
N2 - Background: Five definitions of peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) are used in clinical trials; their clinical relevance in coronary bifurcation stenting remains unclear. Objectives: To understand the correlation between PMI and mortality in bifurcation lesions from the DKCRUSH studies. Methods: PMI was defined using serum creatine kinase-myocardial band (CK-MB) values within 48 h of PCI according to the SYNTAX, Fourth Universal Definition of MI (4th UDMI), ISCHEMIA, SCAI, and EXCEL definitions. Overall, 1300 patients with both CK and CK-MB measurements pre- and post-stenting were evaluated. The association of each PMI type and all-cause death or cardiac death at a median of 5.58 years of follow-up was analyzed using Cox regression. Results: In total, 56 (4.3%) patients had PMI. According to SYNTAX, 4th UDMI or ISCHEMIA, SCAI, and EXCEL definitions, PMI occurred in 21 (1.6%), 56 (4.3%), 29 (2.2%), and 32 (2.5%) patients, respectively. All definitions were significantly correlated with unadjusted mortality at the end of follow-up but not at 30 days or 1-year after stenting. PMI using SYNTAX, SCAI, and EXCEL definitions rather than 4th UDMI definition was strongly associated with adjusted all-cause death. By adjusted analysis, PMI according to 4th UDMI, SCAI, and EXCEL definitions but not SYNTAX definition was positively correlated with cardiac death at a median of 5.58 years of follow-up. CK-MB ≥ 5 x UNL strongly enhanced the correlation of CK-MB values with mortality. Conclusions: PMI rate varies with the definition following stenting for bifurcation lesions. PMI defined by SCAI and EXCEL definitions is strongly correlates with adjusted all-cause and cardiac death.
AB - Background: Five definitions of peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) are used in clinical trials; their clinical relevance in coronary bifurcation stenting remains unclear. Objectives: To understand the correlation between PMI and mortality in bifurcation lesions from the DKCRUSH studies. Methods: PMI was defined using serum creatine kinase-myocardial band (CK-MB) values within 48 h of PCI according to the SYNTAX, Fourth Universal Definition of MI (4th UDMI), ISCHEMIA, SCAI, and EXCEL definitions. Overall, 1300 patients with both CK and CK-MB measurements pre- and post-stenting were evaluated. The association of each PMI type and all-cause death or cardiac death at a median of 5.58 years of follow-up was analyzed using Cox regression. Results: In total, 56 (4.3%) patients had PMI. According to SYNTAX, 4th UDMI or ISCHEMIA, SCAI, and EXCEL definitions, PMI occurred in 21 (1.6%), 56 (4.3%), 29 (2.2%), and 32 (2.5%) patients, respectively. All definitions were significantly correlated with unadjusted mortality at the end of follow-up but not at 30 days or 1-year after stenting. PMI using SYNTAX, SCAI, and EXCEL definitions rather than 4th UDMI definition was strongly associated with adjusted all-cause death. By adjusted analysis, PMI according to 4th UDMI, SCAI, and EXCEL definitions but not SYNTAX definition was positively correlated with cardiac death at a median of 5.58 years of follow-up. CK-MB ≥ 5 x UNL strongly enhanced the correlation of CK-MB values with mortality. Conclusions: PMI rate varies with the definition following stenting for bifurcation lesions. PMI defined by SCAI and EXCEL definitions is strongly correlates with adjusted all-cause and cardiac death.
KW - all-cause death
KW - cardiac death
KW - coronary artery bifurcation lesions
KW - drug-eluting stent
KW - peri-procedural myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=85114730470&partnerID=8YFLogxK
U2 - 10.1002/ccd.29946
DO - 10.1002/ccd.29946
M3 - Article
AN - SCOPUS:85114730470
VL - 99
SP - 617
EP - 626
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
SN - 1522-1946
IS - 3
ER -