Definitions of peri-procedural myocardial infarction and the association with one-year mortality: Insights from CHAMPION trials

Christoph B. Olivier, Vandana Sundaram, Deepak L. Bhatt, Sergio Leonardi, Renato D. Lopes, Victoria Y. Ding, Lingyao Yang, Gregg W. Stone, Ph Gabriel Steg, C. Michael Gibson, Christian W. Hamm, Matthew J. Price, Harvey D. White, Manisha Desai, Donald R. Lynch, Robert A. Harrington, Kenneth W. Mahaffey

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Controversies exist over the appropriate definition for peri-procedural myocardial infarction (PPMI) and its association with mortality. This study aims to evaluate one-year survival following percutaneous coronary intervention (PCI) and the association of different definitions of PPMI with survival among patients with stable angina (SA) or acute coronary syndrome (ACS) in the contemporary era. Methods: We used data from the CHAMPION PLATFORM and CHAMPION PCI trials of patients undergoing PCI and conducted univariable and multivariable Cox proportional hazard regression models to evaluate mortality risk during the first year after PCI. A blinded events committee adjudicated suspected PPMI defined by biomarker elevations ≥3× the upper limit of normal (ULN) or new Q-waves. We further analyzed PPMI by the magnitude of CK-MB elevation ([a] 3 to <5× ULN, [b] 5 to <10× ULN, [c] ≥10× ULN) or by the 2nd universal definition of myocardial infarction (UDMICK-MB) excluding patients with evidence of myocardial infarction (MI) prior to PCI. Results: Of 13,968 patients, 11% initially presented with SA, and 89% with ACS. One-year mortality was 3.4% (SA: 1.5%; ACS: 3.6%). PPMI occurred in 6.3% of the patients (3 to <5× ULN: 2.5%; 5 to <10× ULN: 2.1%; ≥10× ULN: 1.6%; UDMICK-MB: 2.7%). After multivariable adjustment, a significantly higher risk of one-year mortality was observed for patients with PPMI compared with patients without PPMI (HR 2.35 [1.74–3.18], p < 0.001; 3 to <5× ULN: 1.55 [0.92–2.62], p = 0.10; 5 to <10× ULN: 1.22 [0.67–2.20], p = 0.52; ≥10× ULN: 4.78 [3.06–7.47], p < 0.001; UDMICK-MB: 2.19 [1.29–3.73], p = 0.004). Conclusion: PPMI occurred in 6.3% of the patients and was associated with increased risk of death within one year. Survival was not significantly impacted by PPMI if defined by periprocedural CK-MB elevations <10× ULN alone and without additional evaluation of symptoms or evidence of ischemia. These findings highlight the importance of PPMI for long-term outcome in the contemporary era and of its definition in the planning and interpretation of clinical trials.

Original languageEnglish
Pages (from-to)96-101
JournalInternational Journal of Cardiology
Volume270
DOIs
Publication statusPublished - 2018

Fingerprint

Myocardial Infarction
Mortality
Percutaneous Coronary Intervention
Stable Angina
Acute Coronary Syndrome
Survival
Symptom Assessment
Proportional Hazards Models
Ischemia
Biomarkers
Clinical Trials

Keywords

  • Acute coronary syndrome
  • Cangrelor
  • CHAMPION
  • Mortality
  • Percutaneous coronary intervention
  • Peri-procedural myocardial infarction
  • Stable angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Definitions of peri-procedural myocardial infarction and the association with one-year mortality : Insights from CHAMPION trials. / Olivier, Christoph B.; Sundaram, Vandana; Bhatt, Deepak L.; Leonardi, Sergio; Lopes, Renato D.; Ding, Victoria Y.; Yang, Lingyao; Stone, Gregg W.; Steg, Ph Gabriel; Gibson, C. Michael; Hamm, Christian W.; Price, Matthew J.; White, Harvey D.; Desai, Manisha; Lynch, Donald R.; Harrington, Robert A.; Mahaffey, Kenneth W.

In: International Journal of Cardiology, Vol. 270, 2018, p. 96-101.

Research output: Contribution to journalArticle

Olivier, CB, Sundaram, V, Bhatt, DL, Leonardi, S, Lopes, RD, Ding, VY, Yang, L, Stone, GW, Steg, PG, Gibson, CM, Hamm, CW, Price, MJ, White, HD, Desai, M, Lynch, DR, Harrington, RA & Mahaffey, KW 2018, 'Definitions of peri-procedural myocardial infarction and the association with one-year mortality: Insights from CHAMPION trials', International Journal of Cardiology, vol. 270, pp. 96-101. https://doi.org/10.1016/j.ijcard.2018.06.034
Olivier, Christoph B. ; Sundaram, Vandana ; Bhatt, Deepak L. ; Leonardi, Sergio ; Lopes, Renato D. ; Ding, Victoria Y. ; Yang, Lingyao ; Stone, Gregg W. ; Steg, Ph Gabriel ; Gibson, C. Michael ; Hamm, Christian W. ; Price, Matthew J. ; White, Harvey D. ; Desai, Manisha ; Lynch, Donald R. ; Harrington, Robert A. ; Mahaffey, Kenneth W. / Definitions of peri-procedural myocardial infarction and the association with one-year mortality : Insights from CHAMPION trials. In: International Journal of Cardiology. 2018 ; Vol. 270. pp. 96-101.
@article{680e0113476f4c1ab19b3e7bfcaa0f1b,
title = "Definitions of peri-procedural myocardial infarction and the association with one-year mortality: Insights from CHAMPION trials",
abstract = "Background: Controversies exist over the appropriate definition for peri-procedural myocardial infarction (PPMI) and its association with mortality. This study aims to evaluate one-year survival following percutaneous coronary intervention (PCI) and the association of different definitions of PPMI with survival among patients with stable angina (SA) or acute coronary syndrome (ACS) in the contemporary era. Methods: We used data from the CHAMPION PLATFORM and CHAMPION PCI trials of patients undergoing PCI and conducted univariable and multivariable Cox proportional hazard regression models to evaluate mortality risk during the first year after PCI. A blinded events committee adjudicated suspected PPMI defined by biomarker elevations ≥3× the upper limit of normal (ULN) or new Q-waves. We further analyzed PPMI by the magnitude of CK-MB elevation ([a] 3 to <5× ULN, [b] 5 to <10× ULN, [c] ≥10× ULN) or by the 2nd universal definition of myocardial infarction (UDMICK-MB) excluding patients with evidence of myocardial infarction (MI) prior to PCI. Results: Of 13,968 patients, 11{\%} initially presented with SA, and 89{\%} with ACS. One-year mortality was 3.4{\%} (SA: 1.5{\%}; ACS: 3.6{\%}). PPMI occurred in 6.3{\%} of the patients (3 to <5× ULN: 2.5{\%}; 5 to <10× ULN: 2.1{\%}; ≥10× ULN: 1.6{\%}; UDMICK-MB: 2.7{\%}). After multivariable adjustment, a significantly higher risk of one-year mortality was observed for patients with PPMI compared with patients without PPMI (HR 2.35 [1.74–3.18], p < 0.001; 3 to <5× ULN: 1.55 [0.92–2.62], p = 0.10; 5 to <10× ULN: 1.22 [0.67–2.20], p = 0.52; ≥10× ULN: 4.78 [3.06–7.47], p < 0.001; UDMICK-MB: 2.19 [1.29–3.73], p = 0.004). Conclusion: PPMI occurred in 6.3{\%} of the patients and was associated with increased risk of death within one year. Survival was not significantly impacted by PPMI if defined by periprocedural CK-MB elevations <10× ULN alone and without additional evaluation of symptoms or evidence of ischemia. These findings highlight the importance of PPMI for long-term outcome in the contemporary era and of its definition in the planning and interpretation of clinical trials.",
keywords = "Acute coronary syndrome, Cangrelor, CHAMPION, Mortality, Percutaneous coronary intervention, Peri-procedural myocardial infarction, Stable angina",
author = "Olivier, {Christoph B.} and Vandana Sundaram and Bhatt, {Deepak L.} and Sergio Leonardi and Lopes, {Renato D.} and Ding, {Victoria Y.} and Lingyao Yang and Stone, {Gregg W.} and Steg, {Ph Gabriel} and Gibson, {C. Michael} and Hamm, {Christian W.} and Price, {Matthew J.} and White, {Harvey D.} and Manisha Desai and Lynch, {Donald R.} and Harrington, {Robert A.} and Mahaffey, {Kenneth W.}",
year = "2018",
doi = "10.1016/j.ijcard.2018.06.034",
language = "English",
volume = "270",
pages = "96--101",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Definitions of peri-procedural myocardial infarction and the association with one-year mortality

T2 - Insights from CHAMPION trials

AU - Olivier, Christoph B.

AU - Sundaram, Vandana

AU - Bhatt, Deepak L.

AU - Leonardi, Sergio

AU - Lopes, Renato D.

AU - Ding, Victoria Y.

AU - Yang, Lingyao

AU - Stone, Gregg W.

AU - Steg, Ph Gabriel

AU - Gibson, C. Michael

AU - Hamm, Christian W.

AU - Price, Matthew J.

AU - White, Harvey D.

AU - Desai, Manisha

AU - Lynch, Donald R.

AU - Harrington, Robert A.

AU - Mahaffey, Kenneth W.

PY - 2018

Y1 - 2018

N2 - Background: Controversies exist over the appropriate definition for peri-procedural myocardial infarction (PPMI) and its association with mortality. This study aims to evaluate one-year survival following percutaneous coronary intervention (PCI) and the association of different definitions of PPMI with survival among patients with stable angina (SA) or acute coronary syndrome (ACS) in the contemporary era. Methods: We used data from the CHAMPION PLATFORM and CHAMPION PCI trials of patients undergoing PCI and conducted univariable and multivariable Cox proportional hazard regression models to evaluate mortality risk during the first year after PCI. A blinded events committee adjudicated suspected PPMI defined by biomarker elevations ≥3× the upper limit of normal (ULN) or new Q-waves. We further analyzed PPMI by the magnitude of CK-MB elevation ([a] 3 to <5× ULN, [b] 5 to <10× ULN, [c] ≥10× ULN) or by the 2nd universal definition of myocardial infarction (UDMICK-MB) excluding patients with evidence of myocardial infarction (MI) prior to PCI. Results: Of 13,968 patients, 11% initially presented with SA, and 89% with ACS. One-year mortality was 3.4% (SA: 1.5%; ACS: 3.6%). PPMI occurred in 6.3% of the patients (3 to <5× ULN: 2.5%; 5 to <10× ULN: 2.1%; ≥10× ULN: 1.6%; UDMICK-MB: 2.7%). After multivariable adjustment, a significantly higher risk of one-year mortality was observed for patients with PPMI compared with patients without PPMI (HR 2.35 [1.74–3.18], p < 0.001; 3 to <5× ULN: 1.55 [0.92–2.62], p = 0.10; 5 to <10× ULN: 1.22 [0.67–2.20], p = 0.52; ≥10× ULN: 4.78 [3.06–7.47], p < 0.001; UDMICK-MB: 2.19 [1.29–3.73], p = 0.004). Conclusion: PPMI occurred in 6.3% of the patients and was associated with increased risk of death within one year. Survival was not significantly impacted by PPMI if defined by periprocedural CK-MB elevations <10× ULN alone and without additional evaluation of symptoms or evidence of ischemia. These findings highlight the importance of PPMI for long-term outcome in the contemporary era and of its definition in the planning and interpretation of clinical trials.

AB - Background: Controversies exist over the appropriate definition for peri-procedural myocardial infarction (PPMI) and its association with mortality. This study aims to evaluate one-year survival following percutaneous coronary intervention (PCI) and the association of different definitions of PPMI with survival among patients with stable angina (SA) or acute coronary syndrome (ACS) in the contemporary era. Methods: We used data from the CHAMPION PLATFORM and CHAMPION PCI trials of patients undergoing PCI and conducted univariable and multivariable Cox proportional hazard regression models to evaluate mortality risk during the first year after PCI. A blinded events committee adjudicated suspected PPMI defined by biomarker elevations ≥3× the upper limit of normal (ULN) or new Q-waves. We further analyzed PPMI by the magnitude of CK-MB elevation ([a] 3 to <5× ULN, [b] 5 to <10× ULN, [c] ≥10× ULN) or by the 2nd universal definition of myocardial infarction (UDMICK-MB) excluding patients with evidence of myocardial infarction (MI) prior to PCI. Results: Of 13,968 patients, 11% initially presented with SA, and 89% with ACS. One-year mortality was 3.4% (SA: 1.5%; ACS: 3.6%). PPMI occurred in 6.3% of the patients (3 to <5× ULN: 2.5%; 5 to <10× ULN: 2.1%; ≥10× ULN: 1.6%; UDMICK-MB: 2.7%). After multivariable adjustment, a significantly higher risk of one-year mortality was observed for patients with PPMI compared with patients without PPMI (HR 2.35 [1.74–3.18], p < 0.001; 3 to <5× ULN: 1.55 [0.92–2.62], p = 0.10; 5 to <10× ULN: 1.22 [0.67–2.20], p = 0.52; ≥10× ULN: 4.78 [3.06–7.47], p < 0.001; UDMICK-MB: 2.19 [1.29–3.73], p = 0.004). Conclusion: PPMI occurred in 6.3% of the patients and was associated with increased risk of death within one year. Survival was not significantly impacted by PPMI if defined by periprocedural CK-MB elevations <10× ULN alone and without additional evaluation of symptoms or evidence of ischemia. These findings highlight the importance of PPMI for long-term outcome in the contemporary era and of its definition in the planning and interpretation of clinical trials.

KW - Acute coronary syndrome

KW - Cangrelor

KW - CHAMPION

KW - Mortality

KW - Percutaneous coronary intervention

KW - Peri-procedural myocardial infarction

KW - Stable angina

UR - http://www.scopus.com/inward/record.url?scp=85048893125&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048893125&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2018.06.034

DO - 10.1016/j.ijcard.2018.06.034

M3 - Article

AN - SCOPUS:85048893125

VL - 270

SP - 96

EP - 101

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -