Christoph B Olivier1, Vandana Sundaram2, Deepak L Bhatt3, Sergio Leonardi4, Renato D Lopes5, Victoria Y Ding2, Lingyao Yang2, Gregg W Stone6, Ph Gabriel Steg7, C Michael Gibson8, Christian W Hamm9, Matthew J Price10, Harvey D White11, Manisha Desai2, Donald R Lynch12, Robert A Harrington13, Kenneth W Mahaffey14. 1. Stanford Center for Clinical Research (SCCR), Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. 2. Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. 3. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA. 4. Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy. 5. Duke University Medical Center, Durham, NC, USA. 6. Columbia University Medical Center and the Cardiovascular Research Foundation, New York City, NY, USA. 7. FACT (French Alliance for Cardiovascular clinical Trials), DHU FIRE, INSERM Unité 1148, Université Paris-Diderot, and Hôpital Bichat, Assistance-Publique-Hôpitaux de Paris, Paris, France, and NHLI, Imperial College, Royal Brompton Hospital, London, UK. 8. Beth Israel Deaconess Medical Center, Division of Cardiology, Boston, MA, USA. 9. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 10. Scripps Clinic and Scripps Translational Science Institute, La Jolla, CA, USA. 11. Green Lane Cardiovascular Service, Auckland, New Zealand. 12. University of Cincinnati College of Medicine, Cincinnati, OH, USA. 13. Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. 14. Stanford Center for Clinical Research (SCCR), Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: kenneth.mahaffey@stanford.edu.
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.
RCT Entities:
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.
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Authors: Matthew A Cavender; Deepak L Bhatt; Gregg W Stone; Harvey D White; Ph Gabriel Steg; C Michael Gibson; Christian W Hamm; Matthew J Price; Sergio Leonardi; Jayne Prats; Efthymios N Deliargyris; Kenneth W Mahaffey; Robert A Harrington Journal: Circulation Date: 2016-08-01 Impact factor: 29.690
Authors: Ph Gabriel Steg; Nicola Greenlaw; Jean-Claude Tardif; Michal Tendera; Ian Ford; Stefan Kääb; Hélène Abergel; Kim M Fox; Roberto Ferrari Journal: Eur Heart J Date: 2012-08-26 Impact factor: 29.983