Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data

作者：Johanne Silvain, Michel Zeitouni, Valeria Paradies, Huili Zheng, Gjin Ndrepepa, Claudio Cavallini, Dimitri N Feldman, Samin Kumar Sharma, Julinda Mehilli, Sebastiano Gili, Emanuele Barbato, Giuseppe Tarantini, Sze‐Yuan Ooi, Clemens von Birgelen, Allan S. Jaffe, Kristian A. Thygesen, Gilles Montalescot, Heerajnarain Bulluck, Derek John Hausenloy · 发表于：European Heart Journal · 年份：2020 · DOI：10.1093/eurheartj/ehaa885 · 被引用次数：129 · 研究领域：Acute Myocardial Infarction Research、Coronary Interventions and Diagnostics、Cardiac, Anesthesia and Surgical Outcomes

AIMS: The prognostic importance of cardiac procedural myocardial injury and myocardial infarction (MI) in chronic coronary syndrome (CCS) patients undergoing elective percutaneous coronary intervention (PCI) is still debated. METHODS AND RESULTS: We analysed individual data of 9081 patients undergoing elective PCI with normal pre-PCI baseline cardiac troponin (cTn) levels. Multivariate models evaluated the association between post-PCI elevations in cTn and 1-year mortality, while an interval analysis evaluated the impact of the size of the myocardial injury on mortality. Our analysis was performed in the overall population and also according to the type of cTn used [52.0% had high-sensitivity cTn (hs-cTn)]. Procedural myocardial injury, as defined by the Fourth Universal Definition of MI (UDMI) [post-PCI cTn elevation ≥1 × 99th percentile upper reference limit (URL)], occurred in 52.8% of patients and was not associated with 1-year mortality [adj odds ratio (OR), 1.35, 95% confidence interval (CI) (0.84-1.77), P = 0.21]. The association between post-PCI cTn elevation and 1-year mortality was significant starting ≥3 × 99th percentile URL. Major myocardial injury defined by post-PCI ≥5 × 99th percentile URL occurred in 18.2% of patients and was associated with a two-fold increase in the adjusted odds of 1-year mortality [2.29, 95% CI (1.32-3.97), P = 0.004]. In the subset of patients for whom periprocedural evidence of ischaemia was collected (n = 2316), Type 4a MI defined by t...