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Periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention

Published:November 26, 2022DOI:https://doi.org/10.1016/j.jjcc.2022.11.005

      Highlights

      • Periprocedural MI remains frequent following PCI among patients with CCS.
      • Identification of risk factors for periprocedural MI may be useful to mitigate the risk of periprocedural complication.
      • The UDMI applied the lower threshold with cTn and more broadly-defined ancillary criteria compared with the SCAI and ARC-2.
      • The frequency and prognostic impact of periprocedural MI varies considerably according to the definitions applied.
      • The clinically relevant definitions should be considered for use in daily practice and clinical trials.

      Abstract

      Percutaneous coronary intervention (PCI) in addition to guideline-directed medical therapy reduces the risk of spontaneous myocardial infarction (MI), urgent revascularization, and improves angina status; however, PCI is associated with an increased risk of periprocedural myocardial injury and MI. Numerous studies have investigated the mechanisms, predictors, and therapeutic strategies for periprocedural MI. Various definitions of periprocedural MI have been proposed by academic groups and professional societies requiring different cardiac biomarker thresholds and ancillary criteria for myocardial ischemia. The frequency and clinical significance of periprocedural MI substantially varies according to the definitions applied. In daily practice, accurate diagnosis of clinically-relevant periprocedural MI is essential because it may have a substantial impact on subsequent patient management. In the clinical trial setting, only clinically relevant periprocedural MI definitions should be applied as a clinical endpoint in order to avoid obscuring meaningful outcomes. In this review, we aim to summarize the mechanisms, predictors, frequency, and prognostic impact of periprocedural MI in patients undergoing PCI and to provide the current perspective on this issue.

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      References

        • Xaplanteris P.
        • Fournier S.
        • Pijls N.H.J.
        • Fearon W.F.
        • Barbato E.
        • Tonino P.A.L.
        • et al.
        Five-year outcomes with PCI guided by fractional flow reserve.
        N Engl J Med. 2018; 379: 250-259
        • Spertus J.A.
        • Jones P.G.
        • Maron D.J.
        • O'Brien S.M.
        • Reynolds H.R.
        • Rosenberg Y.
        • et al.
        Health-status outcomes with invasive or conservative care in coronary disease.
        N Engl J Med. 2020; 382: 1408-1419
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Chaitman B.R.
        • Bax J.J.
        • Morrow D.A.
        • et al.
        Fourth universal definition of myocardial infarction (2018).
        Eur Heart J. 2019; 40: 237-269
        • Moussa I.D.
        • Klein L.W.
        • Shah B.
        • Mehran R.
        • Mack M.J.
        • Brilakis E.S.
        • et al.
        Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI).
        J Am Coll Cardiol. 2013; 62: 1563-1570
        • Garcia-Garcia H.M.
        • McFadden E.P.
        • Farb A.
        • Mehran R.
        • Stone G.W.
        • Spertus J.
        • et al.
        Standardized end point definitions for coronary intervention trials: the Academic Research Consortium-2 Consensus Document.
        Circulation. 2018; 137: 2635-2650
        • Muschart X.
        • Slimani A.
        • Jamart J.
        • Chenu P.
        • Dangoisse V.
        • Gabriel L.
        • et al.
        The different mechanisms of periprocedural myocardial infarction and their impact on in-hospital outcome.
        J Invasive Cardiol. 2012; 24: 655-660
        • Blankenship J.C.
        • Islam M.A.
        • Wood G.C.
        • Iliadis E.A.
        Angiographic adverse events during percutaneous coronary intervention fail to predict creatine kinase-MB elevation.
        Catheter Cardiovasc Interv. 2004; 63: 31-41
        • Ricciardi M.J.
        • Wu E.
        • Davidson C.J.
        • Choi K.M.
        • Klocke F.J.
        • Bonow R.O.
        • et al.
        Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation.
        Circulation. 2001; 103: 2780-2783
        • Selvanayagam J.B.
        • Porto I.
        • Channon K.
        • Petersen S.E.
        • Francis J.M.
        • Neubauer S.
        • et al.
        Troponin elevation after percutaneous coronary intervention directly represents the extent of irreversible myocardial injury: insights from cardiovascular magnetic resonance imaging.
        Circulation. 2005; 111: 1027-1032
        • Lansky A.J.
        • Stone G.W.
        Periprocedural myocardial infarction: prevalence, prognosis, and prevention.
        Circ Cardiovasc Interv. 2010; 3: 602-610
        • Babu G.G.
        • Walker J.M.
        • Yellon D.M.
        • Hausenloy D.J.
        Peri-procedural myocardial injury during percutaneous coronary intervention: an important target for cardioprotection.
        Eur Heart J. 2011; 32: 23-31
        • Park D.W.
        • Kim Y.H.
        • Yun S.C.
        • Ahn J.M.
        • Lee J.Y.
        • Kim W.J.
        • et al.
        Frequency, causes, predictors, and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention.
        Eur Heart J. 2013; 34: 1662-1669
        • Zeitouni M.
        • Silvain J.
        • Guedeney P.
        • Kerneis M.
        • Yan Y.
        • Overtchouk P.
        • et al.
        Periprocedural myocardial infarction and injury in elective coronary stenting.
        Eur Heart J. 2018; 39: 1100-1109
        • Ueki Y.
        • Otsuka T.
        • Bär S.
        • Koskinas K.C.
        • Heg D.
        • Häner J.
        • et al.
        Frequency and outcomes of periprocedural MI in patients with chronic coronary syndromes undergoing PCI.
        J Am Coll Cardiol. 2022; 79: 513-526
        • Ishibashi Y.
        • Muramatsu T.
        • Nakatani S.
        • Sotomi Y.
        • Suwannasom P.
        • Grundeken M.J.
        • et al.
        Incidence and potential mechanism(s) of post-procedural rise of cardiac biomarker in patients with coronary artery narrowing after implantation of an everolimus-eluting bioresorbable vascular scaffold or everolimus-eluting metallic stent.
        JACC Cardiovasc Interv. 2015; 8: 1053-1063
        • Muramatsu T.
        • Onuma Y.
        • Garcia-Garcia H.M.
        • Farooq V.
        • Bourantas C.V.
        • Morel M.A.
        • et al.
        Incidence and short-term clinical outcomes of small side branch occlusion after implantation of an everolimus-eluting bioresorbable vascular scaffold: an interim report of 435 patients in the ABSORB-EXTEND single-arm trial in comparison with an everolimus-eluting metallic stent in the SPIRIT first and II trials.
        JACC Cardiovasc Interv. 2013; 6: 247-257
        • Hahn J.Y.
        • Chun W.J.
        • Kim J.H.
        • Song Y.B.
        • Oh J.H.
        • Koo B.K.
        • et al.
        Predictors and outcomes of side branch occlusion after main vessel stenting in coronary bifurcation lesions: results from the COBIS II Registry (COronary BIfurcation Stenting).
        J Am Coll Cardiol. 2013; 62: 1654-1659
        • Prasad A.
        • Herrmann J.
        Myocardial infarction due to percutaneous coronary intervention.
        N Engl J Med. 2011; 364: 453-464
        • Zhang D.
        • Li Y.
        • Yin D.
        • He Y.
        • Chen C.
        • Song C.
        • et al.
        Risk stratification of periprocedural myocardial infarction after percutaneous coronary intervention: analysis based on the SCAI definition.
        Catheter Cardiovasc Interv. 2017; 89: 534-540
        • Kini A.
        • Marmur J.D.
        • Kini S.
        • Dangas G.
        • Cocke T.P.
        • Wallenstein S.
        • et al.
        Creatine kinase-MB elevation after coronary intervention correlates with diffuse atherosclerosis, and low-to-medium level elevation has a benign clinical course.
        J Am Coll Cardiol. 1999; 34: 663-671
        • Silvain J.
        • Zeitouni M.
        • Paradies V.
        • Zheng H.L.
        • Ndrepepa G.
        • Cavallini C.
        • et al.
        Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention: a pooled analysis of patient-level data.
        Eur Heart J. 2021; 42: 323-334
        • Koskinas K.C.
        • Ndrepepa G.
        • Raber L.
        • Karagiannis A.
        • Kufner S.
        • Zanchin T.
        • et al.
        Prognostic impact of periprocedural myocardial infarction in patients undergoing elective percutaneous coronary interventions.
        Circ Cardiovasc Interv. 2018; 11e006752
        • Ndrepepa G.
        • Colleran R.
        • Braun S.
        • Cassese S.
        • Hieber J.
        • Fusaro M.
        • et al.
        High-sensitivity troponin T and mortality after elective percutaneous coronary intervention.
        J Am Coll Cardiol. 2016; 68: 2259-2268
        • Feldman D.N.
        • Minutello R.M.
        • Bergman G.
        • Moussa I.
        • Wong S.C.
        Relation of troponin I levels following nonemergent percutaneous coronary intervention to short- and long-term outcomes.
        Am J Cardiol. 2009; 104: 1210-1215
        • Di Serafino L.
        • Borgia F.
        • Maeremans J.
        • Pyxaras S.A.
        • De Bruyne B.
        • Wijns W.
        • et al.
        Periprocedural myocardial injury and long-term clinical outcome in patients undergoing percutaneous coronary interventions of coronary chronic total occlusion.
        J Invasive Cardiol. 2016; 28: 410-414
        • Valgimigli M.
        • Bueno H.
        • Byrne R.A.
        • Collet J.P.
        • Costa F.
        • Jeppsson A.
        • et al.
        2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2018; 39: 213-260
        • Ueki Y.
        • Karagiannis A.
        • Zanchin C.
        • Zanchin T.
        • Stortecky S.
        • Koskinas K.C.
        • et al.
        Validation of high-risk features for stent-related ischemic events as endorsed by the 2017 DAPT guidelines.
        JACC Cardiovasc Interv. 2019; 12: 820-830
        • Kimura S.
        • Sugiyama T.
        • Hishikari K.
        • Yamakami Y.
        • Sagawa Y.
        • Kojima K.
        • et al.
        Association of intravascular ultrasound- and optical coherence tomography-assessed coronary plaque morphology with periprocedural myocardial injury in patients with stable angina pectoris.
        Circ J. 2015; 79: 1944-1953
        • Stone G.W.
        • Maehara A.
        • Muller J.E.
        • Rizik D.G.
        • Shunk K.A.
        • Ben-Yehuda O.
        • et al.
        Plaque characterization to inform the prediction and prevention of periprocedural myocardial infarction during percutaneous coronary intervention: the CANARY Trial (Coronary Assessment by Near-infrared of Atherosclerotic Rupture-prone Yellow).
        JACC Cardiovasc Interv. 2015; 8: 927-936
        • Bulluck H.
        • Paradies V.
        • Barbato E.
        • Baumbach A.
        • Botker H.E.
        • Capodanno D.
        • et al.
        Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: a consensus document of the ESC working group on cellular biology of the heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI).
        Eur Heart J. 2021; 42: 2630-2642
        • Patti G.
        • Cannon C.P.
        • Murphy S.A.
        • Mega S.
        • Pasceri V.
        • Briguori C.
        • et al.
        Clinical benefit of statin pretreatment in patients undergoing percutaneous coronary intervention: a collaborative patient-level meta-analysis of 13 randomized studies.
        Circulation. 2011; 123: 1622-1632
        • Mach F.
        • Baigent C.
        • Catapano A.L.
        • Koskinas K.C.
        • Casula M.
        • Badimon L.
        • et al.
        2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.
        Eur Heart J. 2020; 41: 111-188
        • Ishihara M.
        • Asakura M.
        • Hibi K.
        • Okada K.
        • Shimizu W.
        • Takano H.
        • et al.
        Evolocumab for prevention of microvascular dysfunction in patients undergoing percutaneous coronary intervention: the randomised, open-label EVOCATION trial.
        EuroIntervention. 2022; 18: e647-e655
        • Polimeni A.
        • De Rosa S.
        • Sabatino J.
        • Sorrentino S.
        • Indolfi C.
        Impact of intracoronary adenosine administration during primary PCI: a meta-analysis.
        Int J Cardiol. 2016; 203: 1032-1041
        • Zhao S.
        • Qi G.
        • Tian W.
        • Chen L.
        • Sun Y.
        Effect of intracoronary nitroprusside in preventing no reflow phenomenon during primary percutaneous coronary intervention: a meta-analysis.
        J Interv Cardiol. 2014; 27: 356-364
        • Iwakura K.
        • Ito H.
        • Okamura A.
        • Koyama Y.
        • Date M.
        • Higuchi Y.
        • et al.
        Nicorandil treatment in patients with acute myocardial infarction: a meta-analysis.
        Circ J. 2009; 73: 925-931
        • Hibi K.
        • Kozuma K.
        • Sonoda S.
        • Endo T.
        • Tanaka H.
        • Kyono H.
        • et al.
        A randomized study of distal filter protection versus conventional treatment during percutaneous coronary intervention in patients with attenuated plaque identified by intravascular ultrasound.
        JACC Cardiovasc Interv. 2018; 11: 1545-1555
        • Lawton J.S.
        • Tamis-Holland J.E.
        • Bangalore S.
        • Bates E.R.
        • Beckie T.M.
        • Bischoff J.M.
        • et al.
        2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines.
        Circulation. 2022; 145: e18-e114
        • Neumann F.J.
        • Sousa-Uva M.
        • Ahlsson A.
        • Alfonso F.
        • Banning A.P.
        • Benedetto U.
        • et al.
        2018 ESC/EACTS guidelines on myocardial revascularization.
        Eur Heart J. 2019; 40: 87-165
        • Starnberg K.
        • Jeppsson A.
        • Lindahl B.
        • Hammarsten O.
        Revision of the troponin T release mechanism from damaged human myocardium.
        Clin Chem. 2014; 60: 1098-1104
        • Collet J.P.
        • Thiele H.
        • Barbato E.
        • Barthelemy O.
        • Bauersachs J.
        • Bhatt D.L.
        • et al.
        2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.
        Eur Heart J. 2021; 42: 1289-1367
        • Miller W.L.
        • Garratt K.N.
        • Burritt M.F.
        • Lennon R.J.
        • Reeder G.S.
        • Jaffe A.S.
        Baseline troponin level: key to understanding the importance of post-PCI troponin elevations.
        Eur Heart J. 2006; 27: 1061-1069
        • Prasad A.
        • Rihal C.S.
        • Lennon R.J.
        • Singh M.
        • Jaffe A.S.
        • Holmes Jr., D.R.
        Significance of periprocedural myonecrosis on outcomes after percutaneous coronary intervention: an analysis of preintervention and postintervention troponin T levels in 5487 patients.
        Circ Cardiovasc Interv. 2008; 1: 10-19
        • Levine G.N.
        • Bates E.R.
        • Blankenship J.C.
        • Bailey S.R.
        • Bittl J.A.
        • Cercek B.
        • et al.
        2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines and the Society for Cardiovascular Angiography and Interventions.
        J Am Coll Cardiol. 2011; 58: e44-e122
        • Lim C.C.
        • van Gaal W.J.
        • Testa L.
        • Cuculi F.
        • Arnold J.R.
        • Karamitsos T.
        • et al.
        With the "universal definition," measurement of creatine kinase-myocardial band rather than troponin allows more accurate diagnosis of periprocedural necrosis and infarction after coronary intervention.
        J Am Coll Cardiol. 2011; 57: 653-661
        • Cutlip D.E.
        • Windecker S.
        • Mehran R.
        • Boam A.
        • Cohen D.J.
        • van Es G.A.
        • et al.
        Clinical end points in coronary stent trials: a case for standardized definitions.
        Circulation. 2007; 115: 2344-2351
        • Thygesen K.
        • Alpert J.S.
        • White H.D.
        Joint ESC/ACCF/AHA/WHF task force for the redefinition of myocardial infarction. Universal definition of myocardial infarction.
        Eur Heart J. 2007; 28: 2525-2538
        • Thygesen K.
        • Alpert J.S.
        • Jaffe A.S.
        • Simoons M.L.
        • Chaitman B.R.
        • White H.D.
        • et al.
        Third universal definition of myocardial infarction.
        Circulation. 2012; 126: 2020-2035
        • Novack V.
        • Pencina M.
        • Cohen D.J.
        • Kleiman N.S.
        • Yen C.H.
        • Saucedo J.F.
        • et al.
        Troponin criteria for myocardial infarction after percutaneous coronary intervention.
        Arch Intern Med. 2012; 172: 502-508
        • Maron D.J.
        • Hochman J.S.
        • Reynolds H.R.
        • Bangalore S.
        • O'Brien S.M.
        • Boden W.E.
        • et al.
        Initial invasive or conservative strategy for stable coronary disease.
        N Engl J Med. 2020; 382: 1395-1407
        • Chaitman B.R.
        • Alexander K.P.
        • Cyr D.D.
        • Berger J.S.
        • Reynolds H.R.
        • Bangalore S.
        • et al.
        Myocardial infarction in the ISCHEMIA Trial: impact of different definitions on incidence, prognosis, and treatment comparisons.
        Circulation. 2021; 143: 790-804
        • Yang X.
        • Tamez H.
        • Lai C.
        • Ho K.
        • Cutlip D.
        Type 4a myocardial infarction: incidence, risk factors, and long-term outcomes.
        Catheter Cardiovasc Interv. 2017; 89: 849-856
        • Ferreira R.M.
        • de Souza E.S.N.A.
        • Salis L.H.A.
        • da Silva R.R.M.
        • Maia P.D.
        • Horta L.F.B.
        • et al.
        Troponin I elevation and all-cause mortality after elective percutaneous coronary interventions.
        Cardiovasc Revasc Med. 2017; 18: 255-260
        • Cottens D.
        • Maeremans J.
        • McCutcheon K.
        • Lamers S.
        • Roux L.
        • Duponselle J.
        • et al.
        Prognostic value of the high-sensitivity troponin T assay after percutaneous intervention of chronic total occlusions.
        J Cardiovasc Med (Hagerstown). 2018; 19: 366-372
        • Tricoci P.
        • Newby L.K.
        • Clare R.M.
        • Leonardi S.
        • Gibson C.M.
        • Giugliano R.P.
        • et al.
        Prognostic and practical validation of current definitions of myocardial infarction associated with percutaneous coronary intervention.
        JACC Cardiovasc Interv. 2018; 11: 856-864
        • Garcia-Garcia H.M.
        • McFadden E.P.
        • von Birgelen C.
        • Rademaker-Havinga T.
        • Spitzer E.
        • Kleiman N.S.
        • et al.
        Impact of periprocedural myocardial biomarker elevation on mortality following elective percutaneous coronary intervention.
        JACC Cardiovasc Interv. 2019; 12: 1954-1962
        • Wang H.-Y.
        • Xu B.
        • Dou K.
        • Guan C.
        • Song L.
        • Huang Y.
        • et al.
        Implications of periprocedural myocardial biomarker elevations and commonly used MI definitions after left main PCI.
        JACC Cardiovasc Interv. 2021; 14: 1623-1634
        • Goliasch G.
        • Winter M.P.
        • Ayoub M.
        • Bartko P.E.
        • Gebhard C.
        • Mashayekhi K.
        • et al.
        A contemporary definition of periprocedural myocardial injury after percutaneous coronary intervention of chronic total occlusions.
        JACC Cardiovasc Interv. 2019; 12: 1915-1923
        • Prasad A.
        • Gersh B.J.
        • Bertrand M.E.
        • Lincoff A.M.
        • Moses J.W.
        • Ohman E.M.
        • et al.
        Prognostic significance of periprocedural versus spontaneously occurring myocardial infarction after percutaneous coronary intervention in patients with acute coronary syndromes: an analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.
        J Am Coll Cardiol. 2009; 54: 477-486
        • Damman P.
        • Wallentin L.
        • Fox K.A.
        • Windhausen F.
        • Hirsch A.
        • Clayton T.
        • et al.
        Long-term cardiovascular mortality after procedure-related or spontaneous myocardial infarction in patients with non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II, ICTUS, and RITA-3 trials (FIR).
        Circulation. 2012; 125: 568-576
        • Bangalore S.
        • Pencina M.J.
        • Kleiman N.S.
        • Cohen D.J.
        Prognostic implications of procedural vs spontaneous myocardial infarction: results from the evaluation of drug eluting stents and ischemic events (EVENT) registry.
        Am Heart J. 2013; 166: 1027-1034
        • Leonardi S.
        • Thomas L.
        • Neely M.L.
        • Tricoci P.
        • Lopes R.D.
        • White H.D.
        • et al.
        Comparison of the prognosis of spontaneous and percutaneous coronary intervention-related myocardial infarction.
        J Am Coll Cardiol. 2012; 60: 2296-2304
        • Liu Y.
        • Wang W.
        • Song J.
        • Zhang K.
        • Wang K.
        • Shao C.
        • et al.
        Prognosis of spontaneous myocardial infarction and various definitions of periprocedural myocardial infarction in patients who underwent percutaneous coronary intervention.
        Int J Cardiol. 2021; 333: 60-68
        • Boden W.E.
        • O'Rourke R.A.
        • Teo K.K.
        • Hartigan P.M.
        • Maron D.J.
        • Kostuk W.J.
        • et al.
        Optimal medical therapy with or without PCI for stable coronary disease.
        N Engl J Med. 2007; 356: 1503-1516