Abstract
Objectives: We aimed to investigate 1) the association between biomarker elevation with CK-MB or cTn following PCI and mortality in patients undergoing LM PCI for acute myocardial infarction (AMI), and 2) the prognostic impact of periprocedural myocardial reinfarction rates according to various PMI definitions on long-term mortality. Methods: The study enrolled 313 consecutive AMI patients undergoing LM PCI at a single center from January 2009 to December 2016. CK-MB and cTn were routinely collected at baseline and at frequent intervals between 8 and 48 hours after PCI. Periprocedural myocardial reinfarction was adjudicated occurring within 48 h of PCI according to definitions of the SCAI, ARC-2, and 4th UDMI. The primary and secondary outcomes were the covariate-adjusted 3-year rates of cardiovascular (CV) mortality. Results: 28.2% and 51.2% of patients had a new absolute increase (≥1хURL) in CK-MB and cTnI values, respectively. Compared with patients with absolute post-procedural <1х URL, the risk of 3-year CV death was higher in those with absolute post-procedural CK-MB levels of ≥1хURL (HR: 2.67, 95% CI: 1.11-6.41), ≥3хURL (HR: 4.95 [2.05-11.95]), ≥5х URL (HR: 4.50 [1.73-11.27]), ≥10х URL (HR: 8.36 [3.21-21.78]), ≥35х URL (HR: 77.12 [14.13-421.07]), respectively. We did not observe an incremental CV mortality rate using a higher isolated cTnI cutoff (≥1хURL, HR: 3.02 [0.61-14.95]; ≥3хURL, HR: 4.03 [0.81-20.00]; ≥5хURL, HR: 2.93 [0.70-12.26]; ≥10хURL, HR: 2.19 [0.55-8.77]; ≥35хURL, HR: 0.73 [0.09-5.93]). Periprocedural myocardial reinfarction rates (SCAI, ARC-2, and 4th UDMI) were 8.0%, 12.5%, and 20.4%, respectively. SCAI-defined periprocedural myocardial reinfarction was associated with a 7-fold increase in adjusted hazards of 3-year CV mortality (adjusted HR: 6.88; 95% CI: 2.66-17.77), which had greater prognostic relevance than ARC-2 and 4th UDMI (ARC-2, adjusted HR: 3.07 [1.15-8.20]; 4th UDMI, adjusted HR: 2.60 [1.04-6.50]). Conclusions: In a large cohort of consecutive patients with AMI undergoing LM PCI, periprocedural myocardial reinfarction according to the SCAI, ARC-2, and 4th UDMI definitions were both associated with significant risk for 3- year CV mortality, with the patients with SCAI definition having a higher risk for CV death.
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