Periprocedural myocardial infarction is not associated with an increased risk of long-term cardiac mortality after coronary bifurcation stenting

Abstract

Background: Debate continues over the importance of periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI). We evaluated the prognostic significance of PMI in patients undergoing PCI for bifurcation lesions.

Methods: Between January 2004 and June 2006, patients from 16 centers who received non-left main bifurcation lesion PCIs were enrolled. PMI was defined as a peak creatine kinase-myocardial band (CK-MB) ≥ 3 times the upper limit of normal after PCI. We compared long-term cardiac mortality between patients with and without PMI.

Results: Among the 1188 patients, PMI occurred in 119 (10.0%). Left ventricular ejection fraction<50% (adjusted hazard ratio [HR]: 2.08, 95% confidence interval [CI]: 1.13-3.82, p=0.018), multi-vessel coronary artery disease (adjusted HR: 2.28, 95% CI: 1.36-3.81, p=0.002), and PCI-related acute closure in a side branch (adjusted HR: 3.34, 95% CI: 1.23-9.02, p=0.018) were the significant risk factors for PMI. During the median follow-up of 22.7 months, the unadjusted rate of long-term cardiac mortality was significantly higher in patients with PMI than in those without PMI (2.5% vs. 0.7%, p=0.026). After multivariable adjustment, the relationship between PMI and short-term (≤ 30 day) cardiac mortality was significant (adjusted HR: 12.32, 95% CI: 1.07-141.37, p=0.044). However, PMI was not an independent prognostic factor of long-term cardiac mortality (adjusted HR: 2.59, 95% CI: 0.62-10.85, p=0.20).

Conclusions: PMI occurs in patients with a higher prevalence of adverse cardiac risks and predicts short-term but not long-term cardiac mortality in patients undergoing bifurcation lesion PCI.

Trial registration: ClinicalTrials.gov NCT00851526.

Keywords: Bifurcation lesion; Myocardial infarction; Percutaneous transluminal coronary angioplasty.