Original title: Comparison of the Prognosis of Spontaneous and Percutaneous Coronary Intervention–Related Myocardial Infarction. Reference: Sergio Leonardi, MD et al. Journal of the American College of Cardiology Vol. 60, No. 22, 2012
Clinical significance of myocardial infarction (MI) associated to coronary angioplasty is a controversial issue worldwide. Most of research on coronary disease includes it as a primary end point weighed against spontaneous MI.
The aim of this study was to compare periprocedural MI vs. spontaneous MI. It analyzed data from 9,087 patients enrolled in two trials that assessed Non ST Segment Elevation Acute Coronary Syndrome (EARLY-ACS and SYNERGY): among these, 893 periprocedural MI and 298 spontaneous MI occurred, and ratios for death at 12 months were compared.
Authors defined periprocedural MI as CK-MB more than 3 times the ULN (upper limit of normal). Adjusted hazard ratios for 1-year death were 1.39 (95% CI: 1.01 to 1.89) for periprocedural MI vs. 5.37 (95% CI: 3.9 to 7.38) for spontaneous MI. In determining the CK-Mb threshold for periprocedural MI to achieve the same prognosis as spontaneous MI, it was observed that elevations of 27 times the ULN were necessary for this to happen.
Conclusion
The definition of periprocedural infarction used in clinical trials is poorly associated to events, compared to spontaneous infarction.
Editorial Comment:
This study confirms an assumption based on intuition, that cardiac enzymes elevation after angioplasty does not have the same prognosis than Type 1 MI. Further evaluation is required to confirm these results using the new definition of periprocedural MI (a 5 times increase of troponin levels with clinical or electrical signs or ischemia image). Despite the above observations, this study is good news for interventional cardiologists.
Courtesy of María Sol Andres, MD
Hospital Universitario
Fundación Favaloro – Argentina
Dra. María Sol Andrés para SOLACI.ORG