Peri-Procedural Infarction: More Frequent than and Not as Innocent as We Thought

Almost 30% of all patients experience some degree of myocardial injury after elective angioplasty, a statistic associated to an increase in cardiovascular events at 30 days and 1 year, according to this study recently published in Eur Heart J.

The study only included consecutive patients who underwent elective angioplasty with a negative troponin level at admission. The primary endpoint was defined as a composite of peri-procedural infarction (type 4a infarction), stent thrombosis (type 4b), and myocardial injury according to the third universal definition of infarction.

Multivariable analysis was performed to identify independent predictors of infarction and myocardial injury, and their relation to 30-day and 1-year events.

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Among 1390 patients who underwent elective angioplasty, the primary endpoint was observed in 28.7% of cases, including 7.0% of type 4a infarction, 0.14% of type 4b infarction, and 21.6% of myocardial injury.

Independent risk factors were left main disease, total stent length >30 mm, multiple stenting, chronic kidney disease (estimated glomerular filtration rate <60 mL/min), and age >75 years old.

At 30 days, patients with peri-procedural infarction or myocardial injury had a higher rate of cardiovascular events (5.5% vs. 1.2%; p < 0.001), which was mainly driven by ischemic events (3.2% vs. 0.6%; p < 0.0001).

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At 1 year, the risk of events remained higher for patients with peri-procedural infarction or myocardial injury (p = 0.004).

Conclusion

Peri-procedural infarction and myocardial injury are frequent complications of elective angioplasty and are associated with an increase in cardiovascular events at 30 days and 1 year.

Original title: Periprocedural Myocardial Infarction and Injury in Elective Coronary Stenting.

Reference: Michel Zeitouni et al. Eur Heart J. 2018 Apr 1;39(13):1100-1109.

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