Mortality after periprocedural myocardial injury and spontaneous myocardial infarction according to the levels of troponin increase: insights from a large PCI registry

Abstract

Abstract Background Periprocedural myocardial injury and spontaneous myocardial infarction (MI) are potential complications in patients with coronary artery disease. The prognostic impact of periprocedural myocardial injury as compared to that of spontaneous MI has not been fully assessed. Aim To assess the impact on mortality of periprocedural myocardial injury and spontaneous MI according to thresholds of troponin increase proposed in expert consensus documents. Methods Among patients undergoing PCI at a large volume center, we included those presenting with: 1) chronic coronary syndrome (CCS) with normal (≤1x upper reference level [URL]) cardiac troponin I (cTnI) at baseline and after PCI (no myocardial events); 2) CCS with normal baseline cTnI and increased (>1 URL) cTnI in the 48 hours after PCI (periprocedural myocardial injury), and 3) type I MI (spontaneous MI). Patients with missing cTnI values, patients with CCS and increased baseline cTnI (>1 URL) and patients with unstable angina were excluded. Patients with periprocedural myocardial injury and spontaneous MI were stratified in 4 groups according to the cTnI peak value: 1-5, 5-35, 35-70, >70 times (x) above the URL. The risk of all-cause death at 1-year after PCI was assessed across the cTnI strata using the group with no myocardial events as reference. The conventional cTnI was measured with the Architect methodology (Abbott, Chicago, Illinois) and the URL was 0.4 ng/mL. Results Among patients undergoing PCI between 2012 and 2019, 7602 had no myocardial events, 913 had periprocedural myocardial injury and 2192 presented with spontaneous MI. CTnI peak was 1-5x, 5-35x, 35-70x, >70x above URL in 53%, 41%, 4%, 2% of patients with periprocedural myocardial injury, respectively, and in 24%, 38%, 11%, 26% of patients with spontaneous MI, respectively (Figure 1). Rate of all-cause death was 1.4% in patients with no myocardial events. The risk of all-cause death at 1-year was increased after periprocedural myocardial injury with a peak cTnI of 35-70x URL and tended to be higher with a peak cTnI >70x URL (Figure 2). Among patients with spontaneous MI, the risk of all-cause death was significantly higher in all cTnI strata (Figure 2). Adjusted results and p-value for comparisons between periprocedural myocardial injury and spontaneous MI will be presented at ESC 2023. Conclusions All-cause death at 1-year was not increased after periprocedural myocardial injury with a peak cTnI ≤35x URL. Periprocedural myocardial injury with cTnI peak >35x URL and spontaneous MI with any cTnI elevation were associated with a similar crude risk of all-cause death.Figure 2