Tomotaka Dohi1, Akiko Maehara2, Bernhard Witzenbichler1, Michael J Rinaldi1, Ernest L Mazzaferri1, Peter L Duffy1, Giora Weisz1, Franz-Josef Neumann1, Timothy D Henry1, David A Cox1, Thomas D Stuckey1, Bruce R Brodie1, Claire Litherland1, Sorin J Brener1, Ajay J Kirtane1, Gary S Mintz1, Gregg W Stone1. 1. From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The Ohio State University, Columbus (E.L.M.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freibrug Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (T.D.H.); Cedars-Sinai Medical Center, Los Angeles, CA (T.D.H.); Lehigh Valley Health Network, Allentown, PA (D.A.C.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.); and New York Methodist Hospital, Brooklyn (S.J.B.). 2. From the Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York (T.D., A.M., G.W., A.J.K., G.W.S.); Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (T.D., A.M., G.W., C.L., S.J.B., A.J.K., G.S.M., G.W.S.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); The Ohio State University, Columbus (E.L.M.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Department of Cardiology and Angiology II, Universitäts-Herzzentrum Freibrug Bad Krozingen, Bad Krozingen, Germany (F.-J.N.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (T.D.H.); Cedars-Sinai Medical Center, Los Angeles, CA (T.D.H.); Lehigh Valley Health Network, Allentown, PA (D.A.C.); LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (T.D.S., B.R.B.); and New York Methodist Hospital, Brooklyn (S.J.B.). amaehara@crf.org.
Abstract
BACKGROUND: The frequency, causes, and impact of myocardial infarction (MI) after successful percutaneous coronary intervention have not been well studied. METHODS AND RESULTS: The Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) study was a prospective, multicenter registry study of 8582 patients undergoing successful drug-eluting stent implantation at 11 centers in the United States and Germany. After excluding 128 patients with periprocedural MI, we investigated the pathogenesis, frequency, and long-term consequences of non-periprocedural MI in 8454 patients. MI during 2-year follow-up developed in 263 patients (3.3%) at a median (25th and 75th percentiles) time of 318 (129, 503) days. The 263 MIs were subclassified as spontaneous MI (n=78; 29.7%), secondary or indeterminate MI (n=64; 24.3%), stent thrombosis-related MI (n=63; 24.0%), and in-stent restenosis-related MI (n=58; 22.1%). Multivariable predictors of MI included clinical and angiographic factors (acute coronary syndromes presentation, diabetes mellitus, current smoker, multivessel disease, treatment of an in-stent restenotic lesion), laboratory findings (low baseline hemoglobin and reduced creatinine clearance), antiplatelet agent-related factors (higher on-treatment platelet P2Y12 receptor reactivity and premature thienopyridine discontinuation), and not being on a statin at discharge. Patients who experienced an MI during the follow-up period had significantly greater 2-year mortality than those without MI (17.3% [42 deaths] versus 3.4% [265 deaths], P<0.001). By multivariable analysis, the adjusted hazard ratio (95% confidence interval) for subsequent mortality during follow-up was 2.17 (1.06, 4.45) in patients with versus without a non-periprocedural MI (P=0.03). CONCLUSIONS: The occurrence of a non-periprocedural MI within 2 years after successful drug-eluting stent implantation is relatively infrequent, but has numerous etiologies and is significantly associated with subsequent mortality. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
BACKGROUND: The frequency, causes, and impact of myocardial infarction (MI) after successful percutaneous coronary intervention have not been well studied. METHODS AND RESULTS: The Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) study was a prospective, multicenter registry study of 8582 patients undergoing successful drug-eluting stent implantation at 11 centers in the United States and Germany. After excluding 128 patients with periprocedural MI, we investigated the pathogenesis, frequency, and long-term consequences of non-periprocedural MI in 8454 patients. MI during 2-year follow-up developed in 263 patients (3.3%) at a median (25th and 75th percentiles) time of 318 (129, 503) days. The 263 MIs were subclassified as spontaneous MI (n=78; 29.7%), secondary or indeterminate MI (n=64; 24.3%), stent thrombosis-related MI (n=63; 24.0%), and in-stent restenosis-related MI (n=58; 22.1%). Multivariable predictors of MI included clinical and angiographic factors (acute coronary syndromes presentation, diabetes mellitus, current smoker, multivessel disease, treatment of an in-stent restenotic lesion), laboratory findings (low baseline hemoglobin and reduced creatinine clearance), antiplatelet agent-related factors (higher on-treatment platelet P2Y12 receptor reactivity and premature thienopyridine discontinuation), and not being on a statin at discharge. Patients who experienced an MI during the follow-up period had significantly greater 2-year mortality than those without MI (17.3% [42 deaths] versus 3.4% [265 deaths], P<0.001). By multivariable analysis, the adjusted hazard ratio (95% confidence interval) for subsequent mortality during follow-up was 2.17 (1.06, 4.45) in patients with versus without a non-periprocedural MI (P=0.03). CONCLUSIONS: The occurrence of a non-periprocedural MI within 2 years after successful drug-eluting stent implantation is relatively infrequent, but has numerous etiologies and is significantly associated with subsequent mortality. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
Authors: Katsiaryna Bykov; Sebastian Schneeweiss; Robert J Glynn; Murray A Mittleman; David W Bates; Joshua J Gagne Journal: Drug Saf Date: 2017-10 Impact factor: 5.606