Predictors Of Periprocedural Myocardial Injury Research Articles

Clinical impact and predictors of periprocedural myocardial injury among patients undergoing left bundle branch area pacing.

The clinical impact of Periprocedural myocardial injury (PMI) in patients undergoing permanent pacemaker implantation with Left Bundle Branch Area Pacing (LBBAP) is unknown. 130 patients undergoing LBBAP from January 2020 to June 2021 and completing 12months follow up were enrolled to assess the impact of PMI on composite clinical outcome (CCO) defined as any of the following: all-cause death, hospitalization for heart failure (HHF), hospitalization for acute coronary syndrome (ACS) and ventricular arrhythmias (VAs). High sensitivity Troponin T (HsTnT) was measured up to 24-h after intervention to identify the peak HsTnT values. PMI was defined as increased peak HsTnT values at least > 99th percentile of the upper reference limit (URL: 15pg/ml) in patients with normal baseline values. PMI occurred in 72 of 130 patients (55%). ROC analysis yielded a post-procedural peak HsTnT cutoff of fourfold the URL for predicting the CCO (AUC: 0.692; p = 0.023; sensitivity 73% and specificity 71%). Of the enrolled patients, 20% (n = 26) had peak HsTnT > fourfold the URL. Patients with peak HsTnT > fourfold the URL exhibited a higher incidence of the CCO than patients with peak HsTnT ≤ fourfold the URL (31% vs. 10%; p = 0.005), driven by more frequent hospitalizations for ACS (15% vs. 3%; p = 0.010). Multiple (> 2) lead repositions attempts, the use of septography and stylet-driven leads were independent predictors of higher risk of PMI with peak HsTnT > fourfold the URL. PMI seems common among patients undergoing LBBAP and may be associated with an increased risk of clinical outcomes in case of more pronounced (peak HsTnT > fourfold the URL) myocardial damage occurring during the procedure.

Rapid three-dimensional quantification of high-intensity plaques from coronary atherosclerosis T1-weighted characterization to predict periprocedural myocardial injury

BackgroundHigh-intensity plaque (HIP) on magnetic resonance imaging (MRI) has been documented as a powerful predictor of periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI). Despite the recent proposal of three-dimensional HIP quantification to enhance the predictive capability, the conventional pulse sequence, which necessitates the separate acquisition of anatomical reference images, hinders accurate three-dimensional segmentation along the coronary vasculature. Coronary atherosclerosis T1-weighted characterization (CATCH) enables the simultaneous acquisition of inherently coregistered dark-blood plaque and bright-blood coronary artery images. We aimed to develop a novel HIP quantification approach using CATCH and to ascertain its superior predictive performance compared to the conventional two-dimensional assessment based on plaque-to-myocardium signal intensity ratio (PMR). MethodsIn this prospective study, CATCH MRI was conducted before elective stent implantation in 137 lesions from 125 patients. On CATCH images, dedicated software automatically generated tubular three-dimensional volumes of interest on the dark-blood plaque images along the coronary vasculature, based on the precisely matched bright-blood coronary artery images, and subsequently computed PMR and HIP volume (HIPvol). Specifically, HIPvol was calculated as the volume of voxels with signal intensity exceeding that of the myocardium, weighted by their respective signal intensities. PMI was defined as post-PCI cardiac troponin-T > 5 × the upper reference limit. ResultsThe entire analysis process was completed within 3 min per lesion. PMI occurred in 44 lesions. Based on the receiver operating characteristic curve analysis, HIPvol outperformed PMR for predicting PMI (C-statistics, 0.870 [95% CI, 0.805–0.936] vs. 0.787 [95% CI, 0.706–0.868]; p = 0.001). This result was primarily driven by the higher sensitivity HIPvol offered: 0.886 (95% CI, 0.754–0.962) vs. 0.750 for PMR (95% CI, 0.597–0.868; p = 0.034). Multivariable analysis identified HIPvol as an independent predictor of PMI (odds ratio, 1.15 per 10-μL increase; 95% CI, 1.01–1.30, p = 0.035). ConclusionsOur semi-automated method of analyzing coronary plaque using CATCH MRI provided rapid HIP quantification. Three-dimensional assessment using this approach had a better ability to predict PMI than conventional two-dimensional assessment.

Complementary Roles of Near-Infrared Spectroscopy and Intravascular Ultrasound in the Prediction of Periprocedural Myocardial Injury.

Lipid-rich plaque detected by near-infrared spectroscopy (NIRS) and attenuated plaque detected by intravascular ultrasound (IVUS) predict periprocedural myocardial injury (MI) following percutaneous coronary intervention (PCI). Although echolucent plaque detected by IVUS was reported to be associated with a no-reflow phenomenon in acute myocardial infarction, it remains unclear whether echolucent plaque is predictive of periprocedural MI following elective PCI. We aimed to elucidate whether echolucent plaque is independently associated with periprocedural MI after elective PCI and whether the predictive ability for periprocedural MI is improved by the combination of NIRS and IVUS. This retrospective study included 121 lesions of 121 patients who underwent elective NIRS-IVUS-guided stent implantation. Periprocedural MI was defined as post-PCI cardiac troponin T > 70 ng/L. A maximum 4-mm lipid core burden index > 457 was regarded as lipid-rich plaque. Echolucent plaque was defined as the presence on IVUS of an echolucent zone and attenuated plaque as an attenuation arc > 90°. Periprocedural MI occurred in 39 lesions. In multivariable analysis, echolucent plaque, attenuated plaque, and lipid-rich plaque were independent predictors of periprocedural MI. Adding echolucent plaque and attenuated plaque to lipid-rich plaque improved the predictive performance (C statistic 0.825 vs 0.688; P= 0.001). Periprocedural MI increased with the number of predictors: 3% [1/39], 29% [10/34], 47% [14/30], and 78% [14/18] for 0, 1, 2, and 3 predictors, respectively (P < 0.001). Echolucent plaque is a major predictor of periprocedural MI, independently from lipid-rich plaque and attenuated plaque. Compared with NIRS alone, the combination of NIRS with IVUS signatures improves the predictive ability.

Multimodality imaging to identify lipid-rich coronary plaques and predict periprocedural myocardial injury: Association between near-infrared spectroscopy and coronary computed tomography angiography.

This study compares the efficacy of coronary computed tomography angiography (CCTA) and near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) in patients with significant coronary stenosis for predicting periprocedural myocardial injury during percutaneous coronary intervention (PCI). We prospectively enrolled 107 patients who underwent CCTA before PCI and performed NIRS-IVUS during PCI. Based on the maximal lipid core burden index for any 4-mm longitudinal segments (maxLCBI4mm) in the culprit lesion, we divided the patients into two groups: lipid-rich plaque (LRP) group (maxLCBI4mm ≥ 400; n = 48) and no-LRP group (maxLCBI4mm < 400; n = 59). Periprocedural myocardial injury was a postprocedural cardiac troponin T (cTnT) elevation of ≥5 times the upper limit of normal. The LRP group had a significantly higher cTnT (p = 0.026), lower CT density (p < 0.001), larger percentage atheroma volume (PAV) by NIRS-IVUS (p = 0.036), and larger remodeling index measured by both CCTA (p = 0.020) and NIRS-IVUS (p < 0.001). A significant negative linear correlation was found between maxLCBI4mm and CT density (rho = -0.552, p < 0.001). Multivariable logistic regression analysis identified maxLCBI4mm [odds ratio (OR): 1.006, p = 0.003] and PAV (OR: 1.125, p = 0.014) as independent predictors of periprocedural myocardial injury, while CT density was not an independent predictor (OR: 0.991, p = 0.22). CCTA and NIRS-IVUS correlated well to identify LRP in culprit lesions. However, NIRS-IVUS was more competent in predicting the risk of periprocedural myocardial injury.

LDL-C and Total Stent Length are Independent Predictors of Periprocedural Myocardial Injury and Infarction for Unstable Angina Patients Undergoing Elective Percutaneous Coronary Intervention.

BackgroundTo investigate the predictive value of low-density lipoprotein cholesterol (LDL-C), total stent length and number of implanted stents in patients with unstable angina (UA) regarding myocardial injury and infarction during perioperative period.MethodsThree hundred and fifteen consecutive UA patients between January 2015 and June 2018 were retrospectively recruited from two cardiac centers of Hebei Province, China. These patients had normal preprocedural cardiac troponin I (cTnI) and underwent uneventful revascularizations. The predictive value of baseline LDL-C level and total stent length was investigated by linking to post procedural cTnI value in this cohort. Meanwhile, other related clinical and procedural variables were analyzed.ResultsBaseline LDL-C level or LDL-C grade was correlated with post percutaneous coronary intervention (PCI) cTnI levels (r = 0.120, P = 0.01; r = 0.157, P = 0.004). LDL-C grade was an independent risk factor of perioperative myocardial injury and infarction (P < 0.05) after multivariable adjustment. The risk increased with the elevation of baseline LDL-C level. Compared to the lowest level group (<70 mg/dl), the group with 70–99 mg/dl carried three times higher risk (OR = 3.318; 95% CI: 1.167–9.436; P < 0.05). And, patients with LDL-C level ≥100 mg/dl had the worst prognosis (OR = 4.783; 95% CI: 1.736–13.180; P = 0.002). Besides, the study also found that the total length of stent was predictive of perioperative myocardial injury and infarction independently (OR = 1.037; 95% CI: 1.017–1.058; P = 0.001).ConclusionBaseline LDL-C level and total stent length were independent predictors of periprocedural myocardial injury and infarction in UA patients undergoing elective PCI.

Impact of coronary plaque characteristics on periprocedural myocardial injury after elective percutaneous coronary intervention -MDCT and CMR analysis-

Abstract Background Percutaneous coronary intervention (PCI) is often complicated by periprocedural myocardial injury (PMI) manifested by elevated cardiac biomarkers. The occurrence of PMI has been shown to be associated with worse clinical outcome over short- and long-term. Purpose We performed multidetector computed tomography (MDCT) and cardiac magnetic resonance imaging (CMR) to evaluate the relationship between culprit plaque characteristics and PMI. Methods A total of 90 patients who underwent elective PCI were underwent CMR and multidetector coronary tomography before PCI. The high intensity plaque (HIP) on CMR was defined as a coronary plaque to myocardium signal intensity ratio (PMR) of &amp;gt;1.4. The plaque characteristics and the presence of napkin-ring sign (NRS) were analyzed on MDCT. PMI was defined as an increase in cardiac Troponin T levels to more than 5 times the upper limit of normal at 24 h after PCI. Patients were divided into 2 groups according to the presence (Group I, n=26) or absence (Group II, n=64) of PMI. Results Spotty calcification, positive remodeling, low attenuation plaque and NRS on MDCT were significantly more observed in Group I than in Group II. HIP on CMR was significantly more observed in Group I than in Group II. In the multivariable logistic regression analysis, the presence of NRS and HIP were significantly independent predictors of PMI (odds ratio (OR) 4.82, 95% confidence interval 1.13–20.60, P=0.034 and OR 3.66, 95% CI 1.09–12.30, P=0.036, respectively). Moreover, for prediction of PMI, NRS and HIP showed a high positive predictive value of 81%, and their absence showed a high negative predictive value of 91%. Conclusions MDCT and CMR may play an important role in detecting which lesions are high risks for myocardial necrosis after PCI in elective coronary stenting. Funding Acknowledgement Type of funding source: None

Relationship of lipoprotein-associated phospholipase A2(Lp-PLA2) and periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention

BackgroundPercutaneous coronary intervention (PCI) is one of the dominant methods for revascularization in patients with coronary heart disease (CHD). However, periprocedural myocardial injury (PMI) is a frequent complication following PCI and is known to be a predictor of postprocedural cardiovascular morbidity and mortality. Although several studies try to identify serum markers to predict the PMI, there is a little information about the role of lipoprotein-associated phospholipase A2 (Lp-PLA2) as a predictor of PMI. Therefore, we aimed to investigate the relationship of Lp-PLA2 levels and PMI in patients undergoing elective PCI. MethodsThis study included 265 consecutive patients with normal preprocedural cardiac troponin T(cTNT) who received elective PCI. The samples for cTNT were collected at 8, 16, and 24 h after PCI to assess perioperative myocardial injury. The Lp-PLA2 and other serum lipid parameters were measured after 12 fasting hours before PCI. ResultsThe data suggested that the patients with preprocedural high Lp-PLA2 were strongly and independently correlated with the risk of PMI. Pearson correlation analysis showed that preprocedural Lp-PLA2 was significantly positively correlated with postprocedural cTnT elevation (r = 0.694, p < 0.05). Binary logistic regression analysis was used to analyze the risk factors of PMI, we found that Lp-PLA2 was independent risk factor for postprocedural cTnT elevation. The area under Receiver Operating Characteristic curve of Lp-PLA2 was 0.757 (95%CI 0.692 ~ 0.821, p < 0.001), the best cut-off point was 185 ng/ml, sensitivity and specificity were 65.33% and 76.32%. ConclusionOur study demonstrated that preprocedural Lp-PLA2 was associated with postprocedural cTnT elevation and was the independent risk factor of PMI.

Insulin-like growth factor-1 levels predict myocardial injury and infarction after elective percutaneous coronary intervention: an optical coherence tomography study.

IntroductionPeriprocedural myocardial necrosis, which can range from a low level elevation of cardiac biomarkers to a large myocardial infarction (MI), is a common complication after percutaneous coronary intervention (PCI).AimWe hypothesized that insulin-like growth factor-1 (IGF-1) levels may play a protective role in myocardial injury after coronary stent placement and aimed to investigate the relationship between IGF-1 levels and plaque characteristics assessed by optical coherence tomography (OCT).Material and methodsBetween May 2015 and December 2015 we prospectively enrolled 74 patients with stable angina pectoris in whom single de novo coronary artery stenosis was present. PCI was performed according to standard methods. OCT was applied to all patients. TnT was analyzed at admission, before PCI and at 6, 12, 24 and 48 h after PCI. Serum IGF-1 was measured prior to PCI.ResultsA total of 25 (33.7%) patients had periprocedural myocardial injury or type 4a myocardial infarction, and 49 (66.2%) patients had no events. IGF-1 level and reference intimal thickness, medial thickness, and plaque fibrous cap thickness in OCT had strong correlations (r = 0.88, 0.80 and 0.88 respectively, p < 0.001). IGF-1 was an independent predictor of periprocedural myocardial injury or type 4a MI in univariate (OR = 0.929, 95% CI: 0.895–0.964, p < 0.001) and multivariate regression analysis (OR = 0.757, 95% CI: 0.575–0.998, p = 0.04). Based on ROC analysis, the best cut-off value of IGF-1 for predicting periprocedural myocardial injury or type 4a myocardial infarction was 144.5 ng/ml, with a maximum sensitivity of 88% and specificity of 77.6% (AUC = 0.80, 95% CI: 0.69–0.88, p < 0.0001).ConclusionsThe results from this study indicate that low IGF-1 levels are associated with plaque instability assessed by OCT. Low IGF-1 levels may identify patients who are at increased risk for periprocedural myocardial injury/infarction.

Intraluminal Intensity of Blood Speckle on Intravascular Ultrasound, a Novel Predictor of Periprocedural Myocardial Injury After Coronary Stenting

The difference in the intraluminal intensity of blood speckle (IBS) on integrated backscatter-intravascular ultrasound (IB-IVUS) across a coronary artery stenosis (i.e., ΔIBS) has previously shown a negative correlation with fractional flow reserve, reflecting an impaired coronary blood flow. Periprocedural myocardial injury (PMI) after coronary stenting has also been associated with coronary circulatory dysfunction. The aim of this study was to investigate the relation between ΔIBS after coronary stenting and PMI. A total of 180 patients who underwent elective coronary stenting under IVUS guidance for a single lesion were included. Intraluminal IBS was measured using IB-IVUS in cross sections at the ostium of the target vessel and at the distal reference of the stent. ΔIBS was calculated as (distal IBS value) - (ostium IBS value). PMI was defined as an elevation of troponin I >5 times the 99th percentile upper reference limit (>0.45 ng/ml) within 24 hours after the procedure. The mean ΔIBS after coronary stenting was 6.52 ± 5.71. There was a significantly greater use of the rotational atherectomy, the number of stents, the total stent length, and ΔIBS in patients with PMI than those without. In the receiver operating characteristic curve analysis, ΔIBS significantly predicted PMI (area under the curve 0.64, best cut-off value 7.88, p = 0.001). Multiple logistic regression analysis determined that the total stent length, the use of rotational atherectomy, and ΔIBS were independent predictors of PMI. In conclusion, greater ΔIBS assessed by IB-IVUS was significantly associated with PMI after coronary stenting in patients with a stable coronary artery disease.

Efficacy of Multidetector Computed Tomography to Predict Periprocedural Myocardial Injury After Percutaneous Coronary Intervention for Chronic Total Occlusion.

Specific signatures of culprit lesions detected on multidetector computed tomography (MDCT) were identified as predictors of periprocedural myocardial injury (PMI) after percutaneous coronary intervention (PCI) in patients with stable angina; PMI has been shown to be associated with a worse prognosis. We investigated the association between preprocedural culprit lesion characteristics, assessed by MDCT, and PMI after PCI for chronic total occlusion (CTO). From three medical centers, 81 patients who underwent pre-PCI MDCT and CTO PCI, and systematic cardiac troponin (cTn) sampling before and after PCI, were included. Patients were divided into two groups according to the presence or absence of post-PCI cTn elevation. Patient characteristics, MDCT findings, and procedural variables were compared between the two groups. Procedure success was observed in 65 patients (80.2%) and was not associated with PMI. The incidence of PMI was higher in patients treated with the retrograde versus the antegrade approach. On MDCT, lesion length and the presence of the napkin-ring sign were significantly associated with PMI. Multivariate analysis revealed that the lesion length (odds ratio [OR]: 1.04; 95% confidence interval [CI]: 1.01-1.08; P < 0.05), napkin-ring sign (OR: 5.41; 95% CI: 1.01-29.0; P < 0.05), and retrograde approach (OR: 4.78; 95% CI: 1.28-15.4; P < 0.05) were significant predictors of PMI. PMI is not uncommon in patients undergoing elective CTO PCI, regardless of procedure success or failure. Pre-PCI MDCT may help identify patients at high risk for PMI after CTO PCI.

Elevated Plasma High Sensitivity C-reactive Protein (hs-CRP) Level is a Predictor of Periprocedural Myocardial Injury during Percutaneous Coronary Intervention (PCI)

Background: Elevated high sensitivity C-reactive protein (hs-CRP) has been well known as a biomarker reflecting inflammatory process for prediction of ischemic events among patients with coronary artery disease. Relatively small studies have identified a heightened and sustained inflammatory response after percutaneous coronary intervention (PCI) to be a predictor of periprocedural events after coronary angioplasty and a marker of increased restenosis risk among patients undergoing coronary stenting. Embolization of atherosclerotic and thrombotic debris can induce myocardial necrosis during PCI. This study was designed to evaluate whether pre procedural hs-CRP level is associated with procedure related distal microembolization producing myocardial injury (assessed by CK-MB level) after PCI.Methods: A total of 310 patients with chronic stable angina and unstable angina, who would undergo elective PCI were evaluated in National Institute of Cardiovascular Disease (NICVD), Dhaka with a view to evaluate the relationship between preprocedural hs-CRP and rise of CK-MB level, before and after PCI. Patients were divided in 2 groups according to hs-CRP: Group I = hs-CRP &lt;3 mg/ L, Group II = hs-CRP &gt;3 mg/L.Results: A total of 310 patients were divided into two groups: Normal CRP group (n = 131) and elevated CRP group (n= 179). Following PCI, CK-MB level rose from baseline in both groups. In normal CRP group, there was no significant elevation of CK-MB level after PCI (Pre-procedural vs. Post-procedural: 18.6 ± 5.4 vs. 29.1 ± 5.6 mg/L, p= ns). In elevated CRP group, there was significant elevation of CK-MB level after PCI (Preprocedural vs. Post-procedural: 19.1 ± 6.7 vs. 52.46 ± 9.4 mg/L, p &lt; 0.01). The mean rise of CK-MB level was higher in group II than group I (33.06±11.62U/L vs. 11.52±9.60 U/L). The findings were statistically significant between the study groups (p&gt;0.05). Also there was a positive linear correlation between preprocediral hsCRP level and rise of CKMB (r=0.22) following procedure and it was statistically significant (p&lt;0.05). Multivariate logistic regression analysis was done among traditional predictors of PCI outcome including advanced age (&gt;50 years), female gender, diabetes mellitus, BMI, hypertension, smoking, dylipidaemia, type C lesion, multiple stents, post dilatation and hsCRP. After removing the effects of the all other variables, hs- CRP was independent predictor of periprocedural myocardial injury during PCI, assessed by CK-MB elevation with OR 1.57 and p=0.001.Conclusion: The inflammatory activity, as represented by hs-CRP level, is associated with procedure related microvascular injury as assessed by CK-MB elevation after PCI. Measurement of hs-CRP levels could provide a rationale for risk stratification before coronary intervention and may be a useful tool to target aggressive antiaggregatory or anti-inflammatory therapy to patients that are exposed to the highest risk for ischemic complications. As distal microembolization is a determinant of short and long term mortality after PCI, specific strategies may be developed to minimize myocardial injury in subjects with elevated hs-CRP level.Bangladesh Heart Journal 2015; 30(1) : 5-12

Clinical outcomes and risk factors of periprocedural myocardial injury after successful percutaneous coronary intervention for chronic total occlusions

Limited published data about periprocedural myocardial injury (PMI) after successful chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) were available. The study aimed to investigate risk predictors and clinical implications of PMI after successful CTO-PCI and drug-eluting stent (DES) implantation. Between 2009and 2012, a total of 437 patients who underwent successful recanalization with DESs were included. All the cardiac troponin T (cTnT)-positive patients were excluded. As the benchmark in PMI defined as cTnT >5 × the 99th percentile ULN, the independent predictors and major adverse cardiac events (MACEs) involving cardiac death, myocardial infarction, and target-vessel revascularization were compared between the PMI group and the no PMI group. The incidence rate of PMI was 18.3% (80/437) after the index procedure. Multivariate analysis showed that calcification (OR: 2.203, confidence interval [CI] 1.262–3.845, P = 0.005), the parallel wire technique (OR: 3.178, CI 1.661–6.081, P < 0.001), and the retrograde wire technique (OR: 5.554, CI 2.275–13.558, P < 0.001) were independent predictors of PMI after successful CTO-PCI and DES implantation. Major adverse cardiac events were significantly higher in the PMI group (adjusted hazard ratio 3.704; 95% CI 1.759–7.796; P = 0.001) during the 3-year follow-up. The independent predictors of PMI after successful recanalization with DESs are calcification, the parallel wire technique, and the retrograde wire technique. Periprocedural myocardial injury after the index procedure is associated with more adverse clinical events. Further large clinical studies combined with bioinformatics are warranted to explore the implications of patients with this distinct new entity.

TCTAP A-198 Elevated Plasma HsCRP Level Is a Predictor of Periprocedural Myocardial Injury During PCI

TCTAP A-198 Elevated Plasma HsCRP Level Is a Predictor of Periprocedural Myocardial Injury During PCI

PERIPROCEDURAL MYOCARDIAL NECROSIS PREDICTION BY SYNATX SCORE DURING PERCUTANOUS CORONARY INTERVENTION IN DIABETIC PATIENTS

Background: Peri-procedural myocardial injury (PPI) during percutaneous coronary intervention (PCI) is common and associated with a poor outcome. No reliable angiographic or clinical predictors of PPI exist. We evaluated the ability of the SYNTAX score (SXscore), Gensini score and American Heart Association/American College of Cardiology (AHA/ACC) classification to predict PPI. Methods: 60 patients with chronic stable angina not controlled by medical treatment were included from the day case PCI. Inclusion criteria; patients undergoing insertion of 2.0 mm in diameter, and/or patients undergoing double vessel PCI. Exclusion criteria; Patients with heart failure and lesions > 30 mm in length, patients with high syntax high syntax score, Patients with coronary bypass grafts, previous PCI and patients with instent restenosis. PPI was defined as troponin T elevation (N 0.1 ng/mL) at 6–24 h post-PCI. Results: Patients were classified according to presence or absence of diabetes mellitus (DM) into two groups; group I (non-diabetic patients DM; 33 patients, 23 males, 10 females, their age ranged from 42- 62 years with mean 50.2±5.3 years), group II (diabetic patients; 27 patients, 16 males, 11 females, their age ranged from 45 -65 years with mean age of 54.4±5.4 years). Patients were reclassified according to syntax score into two groups; group A (with low score (0-22); 48 patients) & group B (with intermediate score (22-32); 12 patients).The mean patient SXscore was higher in diabetic patients and non diabetic patients (22.6 vs. 12.4, p = 0.0001), Gensini score was significantly higher in diabetic patients (52.4 vs. 25.3, p = 0.15). Also mean PCI vessel SXscore was higher in vessels associated with PPI (12.1 vs. 7.6, p = 0.002), but not different for PCI vessel Gensini score (16.2 vs. 13.6, p = 0.42). No vessels with AHA type A lesions were associated with PPI. Higher AHA classification (B and C) were associated with PPI. In total, 60 patients undergoing PCI to 77 vessels were included in the analysis, There were 43/60 (71.6%) patients who had myocardial injury. The incidence of PPI among diabetic patients was higher than non diabetic patients (24/27, 88.9% vs 19/33, 57.6% respectively) reflecting procedural complexity, (long lesion and total occlusion) more in diabetic patients. Indeed, the procedural complexity reflected by the mean patient SXscore was higher in the diabetic patients group than non diabetic patients undergoing day case PCI. By ROC analysis, we found that a patient with high SXscore of ≥ 15 can be considered as predictor of PPI with a sensitivity of 95.3% and specificity of 88.2%.Conclusion: Higher SXscores are predictive of myocardial injury, whilst AHA type A lesions have a high negative predictive value for PPI.

Impact of chronic kidney disease on the incidence of peri-procedural myocardial injury in patients undergoing elective stent implantation

It is well known that chronic kidney disease is a strong independent predictor of adverse outcomes after percutaneous coronary intervention in patients with ischemic heart disease. Recently, peri-procedural myocardial injury has been associated with adverse cardiac events. The aim of this study was to investigate the relationship between renal function and peri-procedural myocardial injury in patients undergoing elective stent implantation. This study comprised 273 consecutive patients who underwent elective stent implantation. They were divided into two groups: estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m(2) and eGFR ≥60 mL/min/1.73m(2). Peri-procedural TnT levels higher than three times the normal limit were defined as peri-procedural myocardial injury. Patients with eGFR <60 mL/min/1.73m(2) showed a higher incidence of peri-procedural myocardial injury compared to patients with eGFR ≥60 mL/min/1.73m(2) (4.3 versus 20.9%, P < 0.0001). Even after a multivariate adjustment, the eGFR level predicted peri-procedural myocardial injury [odds ratio 0.92, 95% confidence interval (CI): 0.89-0.95, P < 0.0001]. Total stent length was also an independent predictor of peri-procedural myocardial injury (odds ratio 1.09, 95% CI: 1.02-1.16, P = 0.009). Using a receiver-operating curve analysis, eGFR level of 62.1 mL/min/1.73m(2) (sensitivity 93.3%, specificity 57.2%) was the best value (area under the curve = 0.803) to maximize the power of eGFR levels in predicting peri-procedural myocardial injury. Patients with eGFR <60 mL/min/1.73m(2) were strongly associated with peri-procedural myocardial injury after elective stent implantation. Therefore, eGFR may be a simple and convenient predictor of peri-procedural myocardial injury.

The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention

Background Peri-procedural myocardial injury (PPI) during percutaneous coronary intervention (PCI) is common and associated with a poor outcome. No reliable angiographic or clinical predictors of PPI exist. We evaluated the ability of the SYNTAX score (SXscore), Gensini score, American Heart Association/American College of Cardiology (AHA/ACC) and Society for Cardiovascular Angiography and Intervention (SCAI) classifications to predict PPI. Methods Consecutive patients were included from two existing databases of PCI. Patients with coronary bypass grafts or instent restenosis were excluded. PPI was defined as troponin I elevation (> 1.0 μg/L) at 6–24 h post-PCI. Delayed enhancement magnetic resonance imaging distinguished PPI territory in patients undergoing multi-vessel PCI. Quantitative coronary angiography was performed blinded to PPI. In total, 100 patients underwent PCI to 122 vessels. PPI occurred in 20/100 (20.0%) patients. Results Mean patient SXscore was higher in patients with PPI (20.6 vs. 12.4, p = 0.0001), however Gensini score was not significantly different (34.2 vs. 27.3, p = 0.15). Mean vessel SXscore was higher in vessels associated with PPI (12.1 vs. 7.6, p = 0.002), but not different for vessel Gensini score (16.2 vs. 13.6, p = 0.42). No vessels with AHA type A or B1 lesions were associated with PPI. Higher AHA scores (B2 and C) were associated with PPI ( χ 2 for trend 11.6, p = 0.0007). SCAI scores were not predictive of PPI ( χ 2 for trend 3.6, p = 0.06). By ROC analysis, a patient SXscore of ≥ 17 predicted PPI with a sensitivity of 75.0% and specificity of 70.0%. Conclusion Higher SXscores are predictive of myocardial injury, whilst AHA type A and B1 lesions have a high negative predictive value for PPI.