Predictors of Periprocedural Myocardial Injury Following Elective PCI

Main Article Content

Khaled Elsayed Hamada , Mohammed Kamal Salama, Wael Anwar Haseeb, Reda Biomy Bastawisy

Keywords

MACEs, All-Cause Death, Periprocedural Myocardial Injury& PCI.

Abstract

Periprocedsural myocardial injury is associated with major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). The aim of this work was to evaluate the predictors of periprocedural myocardial injury following elective PCI.


Methods: This prospective observational cohort study was carried out on 300 adult cases of both sexes who were diagnosed with chronic coronary syndromes (CCS) and were treated by elective PCI and had normal baseline levels of high sensitivity cardiac troponin I (hs-cTnI). Patients were categorized into two groups according to the post-PCI hs-cTnI level: no post-PCI myocardial injury group with hs-cTnI level (<99th percentile URL) and post-PCI myocardial injury group with elevation of hs-cTnI level > 99th percentile URL.


Results: The multivariate regression analysis illustrated that the age, stent number and total stent length were independent predictors of myocardial injury, while EF, lesion complexity, syntax score, PCI vessels number and average stent diameter were not. CV death, cardiac arrest, MI, MACEs and all cause death were significantly higher in group II than group I.


Conclusions: In CCS patients undergoing elective PCI, age, stent number and total stent length were independent predictors of myocardial injury. Myocardial injury with higher hs-cTnI level > 99th percentile URL was associated with higher risk of CV death, cardiac arrest, MI, MACEs and all cause death.

Abstract 115 | PDF Downloads 39

References

1. Bulluck H, Paradies V, Barbato E, Baumbach A, Bøtker HE, Capodanno D, et al. Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: a Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2021;42:2630-42.
2. Galassi AR, Vadalà G, Werner GS, Cosyns B, Sianos G, Hill J, et al. Evaluation and management of patients with coronary chronic total occlusions considered for revascularisation. A clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC, the European Association of Cardiovascular Imaging (EACVI) of the ESC, and the ESC Working Group on Cardiovascular Surgery. EuroIntervention. 2024;20:174-84.
3. Garcia-Garcia HM, McFadden EP, von Birgelen C, Rademaker-Havinga T, Spitzer E, Kleiman NS, et al. Impact of periprocedural myocardial biomarker elevation on mortality following elective percutaneous coronary intervention. JACC Cardiovasc Interv. 2019;12:1954-62.
4. Silvain J, Zeitouni M, Paradies V, Zheng HL, Ndrepepa G, Cavallini C, et al. Procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data. Eur Heart J. 2021;42:323-34.
5. Zeitouni M, Silvain J, Guedeney P, Kerneis M, Yan Y, Overtchouk P, et al. Periprocedural myocardial infarction and injury in elective coronary stenting. European Heart Journal. 2018;39:1100-9.
6. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2018;40:237-69.
7. Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: Executive summary: A report of the american college of cardiology/american heart association joint committee on clinical practice guidelines. Circulation. 2022;145:4-17.
8. Ellis SG, Vandormael MG, Cowley MJ, DiSciascio G, Deligonul U, Topol EJ, et al. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. Circulation. 1990;82:1193-202.
9. Bryer E, Stein E, Goldberg S. Multivessel coronary artery disease: The limitations of a “one-size-fits-all” approach. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2020;4:638.
10. Zhou Y, Chen Z, Ma J, Chen A, Lu D, Wu Y, et al. Incidence, predictors and clinical significance of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention. Journal of Cardiology. 2020;76:309-16.
11. Sarilar M, Oktay V, Demirci G, Oksen D, Sansoy V. Periprocedural myocardial injury after elective percutaneous coronary intervention in stable angina pectoris: a tertiary center experience. Cor et Vasa. 2023;40:710-5.
12. Ndrepepa G, Braun S, Cassese S, Mayer K, Lohaus R, Lahmann AL, et al. Prognostic value of high-sensitivity troponin T after percutaneous coronary intervention in patients with stable coronary artery disease. Rev Esp Cardiol (Engl Ed). 2016;69:746-53.
13. Kong T, Dai X, Luan B, Zhang X, Hou A, Wang Y. Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion. BMC Cardiovascular Disorders. 2022;22:454.
14. Liu MJ, Chen CF, Gao XF, Liu XH, Xu YZ. Impact of periprocedural myocardial injury on long-term clinical outcomes of chronic total occlusion patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Coron Artery Dis. 2020;31:208-14.
15. Park DW, Kim YH, Yun SC, Ahn JM, Lee JY, Kim WJ, et al. Frequency, causes, predictors, and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention. Eur Heart J. 2013;34:1662-9.
16. Quenot JP, Le Teuff G, Quantin C, Doise JM, Abrahamowicz M, Masson D, et al. Myocardial injury in critically ill patients: relation to increased cardiac troponin I and hospital mortality. Chest. 2005;128:2758-64.
17. van Gaal WJ, Arnold JR, Testa L, Karamitsos T, Lim CC, Ponnuthurai FA, et al. Myocardial injury following coronary artery surgery versus angioplasty (MICASA): a randomised trial using biochemical markers and cardiac magnetic resonance imaging. EuroIntervention. 2011;6:703-10.
18. Prasad A, Herrmann J. Myocardial infarction due to percutaneous coronary intervention. N Engl J Med. 2011;364:453-64.
19. Lo N, Michael TT, Moin D, Patel VG, Alomar M, Papayannis A, et al. Periprocedural myocardial injury in chronic total occlusion percutaneous interventions: a systematic cardiac biomarker evaluation study. JACC Cardiovasc Interv. 2014;7:47-54.
20. Feldman DN, Kim L, Rene AG, Minutello RM, Bergman G, Wong SC. Prognostic value of cardiac troponin-I or troponin-T elevation following nonemergent percutaneous coronary intervention: a meta-analysis. Catheter Cardiovasc Interv. 2011;77:1020-30.
21. Kanaparti PK, Brown DL. Relation between coronary atherosclerotic plaque burden and cardiac enzyme elevation following percutaneous coronary intervention. Am J Cardiol. 2000;86:619-22.