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 language | English |
|---|---|
| Pages (from-to) | 96-101 |
| Journal | International Journal of Cardiology |
| Volume | 270 |
| DOIs | |
| Publication status | Published - 2018 |
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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 journal › Article
}
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 -