Prognostic Significance of Periprocedural Versus Spontaneously Occurring Myocardial Infarction After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes. An Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial

Abhiram Prasad, Bernard J. Gersh, Michel E. Bertrand, A. Michael Lincoff, Jeffrey W. Moses, E. Magnus Ohman, Harvey D. White, Stuart J. Pocock, Brent T. McLaurin, David A. Cox, Alexandra J. Lansky, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Objectives: The aim of this study was to evaluate the relative impact of spontaneously occurring and periprocedural myocardial infarction (MI) on survival after percutaneous coronary intervention (PCI). Background: The clinical significance of periprocedural MI after PCI remains uncertain. Methods: Outcomes during a 1-year follow-up were evaluated among 7,773 patients enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial with a non-ST-segment elevation acute coronary syndrome in whom PCI was performed. Results: Periprocedural MI developed in 466 patients (6.0%), and spontaneous MI unrelated to PCI subsequently developed in 200 patients (2.6%). Patients developing spontaneous and periprocedural MI compared with those patients without MI had significantly greater unadjusted rates of mortality at 30 days (5.0% vs. 3.2% vs. 0.8%, respectively, p < 0.0001) and at 1 year (16.0% vs. 6.0% vs. 2.6%, respectively, p < 0.0001). In a time-updated multivariable analysis, after adjusting for differences in baseline and procedural characteristics between the groups, we found that spontaneous MI was a powerful independent predictor of subsequent mortality (hazard ratio: 7.49, 95% confidence interval: 4.95 to 11.33, p < 0.0001), whereas periprocedural MI was not a significant predictor of mortality (hazard ratio: 1.30, 95% confidence interval: 0.85 to 1.98, p = 0.22). Conclusions: Among patients with acute coronary syndrome undergoing PCI, the spontaneous development of an MI unrelated to PCI is a powerful predictor of subsequent mortality. In contrast, periprocedural MI is a marker of baseline risk, atherosclerosis burden, and procedural complexity but in most cases does not have independent prognostic significance. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158).

Original languageEnglish (US)
Pages (from-to)477-486
Number of pages10
JournalJournal of the American College of Cardiology
Volume54
Issue number5
DOIs
StatePublished - Jul 28 2009

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Triage
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Catheterization
Myocardial Infarction
Mortality
Confidence Intervals
Heparin
Atherosclerosis
Survival

Keywords

  • angioplasty
  • myocardial infarction
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic Significance of Periprocedural Versus Spontaneously Occurring Myocardial Infarction After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes. An Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial. / Prasad, Abhiram; Gersh, Bernard J.; Bertrand, Michel E.; Lincoff, A. Michael; Moses, Jeffrey W.; Ohman, E. Magnus; White, Harvey D.; Pocock, Stuart J.; McLaurin, Brent T.; Cox, David A.; Lansky, Alexandra J.; Mehran, Roxana; Stone, Gregg W.

In: Journal of the American College of Cardiology, Vol. 54, No. 5, 28.07.2009, p. 477-486.

Research output: Contribution to journalArticle

Prasad, Abhiram ; Gersh, Bernard J. ; Bertrand, Michel E. ; Lincoff, A. Michael ; Moses, Jeffrey W. ; Ohman, E. Magnus ; White, Harvey D. ; Pocock, Stuart J. ; McLaurin, Brent T. ; Cox, David A. ; Lansky, Alexandra J. ; Mehran, Roxana ; Stone, Gregg W. / Prognostic Significance of Periprocedural Versus Spontaneously Occurring Myocardial Infarction After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes. An Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial. In: Journal of the American College of Cardiology. 2009 ; Vol. 54, No. 5. pp. 477-486.
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title = "Prognostic Significance of Periprocedural Versus Spontaneously Occurring Myocardial Infarction After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes. An Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial",
abstract = "Objectives: The aim of this study was to evaluate the relative impact of spontaneously occurring and periprocedural myocardial infarction (MI) on survival after percutaneous coronary intervention (PCI). Background: The clinical significance of periprocedural MI after PCI remains uncertain. Methods: Outcomes during a 1-year follow-up were evaluated among 7,773 patients enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial with a non-ST-segment elevation acute coronary syndrome in whom PCI was performed. Results: Periprocedural MI developed in 466 patients (6.0{\%}), and spontaneous MI unrelated to PCI subsequently developed in 200 patients (2.6{\%}). Patients developing spontaneous and periprocedural MI compared with those patients without MI had significantly greater unadjusted rates of mortality at 30 days (5.0{\%} vs. 3.2{\%} vs. 0.8{\%}, respectively, p < 0.0001) and at 1 year (16.0{\%} vs. 6.0{\%} vs. 2.6{\%}, respectively, p < 0.0001). In a time-updated multivariable analysis, after adjusting for differences in baseline and procedural characteristics between the groups, we found that spontaneous MI was a powerful independent predictor of subsequent mortality (hazard ratio: 7.49, 95{\%} confidence interval: 4.95 to 11.33, p < 0.0001), whereas periprocedural MI was not a significant predictor of mortality (hazard ratio: 1.30, 95{\%} confidence interval: 0.85 to 1.98, p = 0.22). Conclusions: Among patients with acute coronary syndrome undergoing PCI, the spontaneous development of an MI unrelated to PCI is a powerful predictor of subsequent mortality. In contrast, periprocedural MI is a marker of baseline risk, atherosclerosis burden, and procedural complexity but in most cases does not have independent prognostic significance. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158).",
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author = "Abhiram Prasad and Gersh, {Bernard J.} and Bertrand, {Michel E.} and Lincoff, {A. Michael} and Moses, {Jeffrey W.} and Ohman, {E. Magnus} and White, {Harvey D.} and Pocock, {Stuart J.} and McLaurin, {Brent T.} and Cox, {David A.} and Lansky, {Alexandra J.} and Roxana Mehran and Stone, {Gregg W.}",
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T1 - Prognostic Significance of Periprocedural Versus Spontaneously Occurring Myocardial Infarction After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes. An Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial

AU - Prasad, Abhiram

AU - Gersh, Bernard J.

AU - Bertrand, Michel E.

AU - Lincoff, A. Michael

AU - Moses, Jeffrey W.

AU - Ohman, E. Magnus

AU - White, Harvey D.

AU - Pocock, Stuart J.

AU - McLaurin, Brent T.

AU - Cox, David A.

AU - Lansky, Alexandra J.

AU - Mehran, Roxana

AU - Stone, Gregg W.

PY - 2009/7/28

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N2 - Objectives: The aim of this study was to evaluate the relative impact of spontaneously occurring and periprocedural myocardial infarction (MI) on survival after percutaneous coronary intervention (PCI). Background: The clinical significance of periprocedural MI after PCI remains uncertain. Methods: Outcomes during a 1-year follow-up were evaluated among 7,773 patients enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial with a non-ST-segment elevation acute coronary syndrome in whom PCI was performed. Results: Periprocedural MI developed in 466 patients (6.0%), and spontaneous MI unrelated to PCI subsequently developed in 200 patients (2.6%). Patients developing spontaneous and periprocedural MI compared with those patients without MI had significantly greater unadjusted rates of mortality at 30 days (5.0% vs. 3.2% vs. 0.8%, respectively, p < 0.0001) and at 1 year (16.0% vs. 6.0% vs. 2.6%, respectively, p < 0.0001). In a time-updated multivariable analysis, after adjusting for differences in baseline and procedural characteristics between the groups, we found that spontaneous MI was a powerful independent predictor of subsequent mortality (hazard ratio: 7.49, 95% confidence interval: 4.95 to 11.33, p < 0.0001), whereas periprocedural MI was not a significant predictor of mortality (hazard ratio: 1.30, 95% confidence interval: 0.85 to 1.98, p = 0.22). Conclusions: Among patients with acute coronary syndrome undergoing PCI, the spontaneous development of an MI unrelated to PCI is a powerful predictor of subsequent mortality. In contrast, periprocedural MI is a marker of baseline risk, atherosclerosis burden, and procedural complexity but in most cases does not have independent prognostic significance. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158).

AB - Objectives: The aim of this study was to evaluate the relative impact of spontaneously occurring and periprocedural myocardial infarction (MI) on survival after percutaneous coronary intervention (PCI). Background: The clinical significance of periprocedural MI after PCI remains uncertain. Methods: Outcomes during a 1-year follow-up were evaluated among 7,773 patients enrolled in the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial with a non-ST-segment elevation acute coronary syndrome in whom PCI was performed. Results: Periprocedural MI developed in 466 patients (6.0%), and spontaneous MI unrelated to PCI subsequently developed in 200 patients (2.6%). Patients developing spontaneous and periprocedural MI compared with those patients without MI had significantly greater unadjusted rates of mortality at 30 days (5.0% vs. 3.2% vs. 0.8%, respectively, p < 0.0001) and at 1 year (16.0% vs. 6.0% vs. 2.6%, respectively, p < 0.0001). In a time-updated multivariable analysis, after adjusting for differences in baseline and procedural characteristics between the groups, we found that spontaneous MI was a powerful independent predictor of subsequent mortality (hazard ratio: 7.49, 95% confidence interval: 4.95 to 11.33, p < 0.0001), whereas periprocedural MI was not a significant predictor of mortality (hazard ratio: 1.30, 95% confidence interval: 0.85 to 1.98, p = 0.22). Conclusions: Among patients with acute coronary syndrome undergoing PCI, the spontaneous development of an MI unrelated to PCI is a powerful predictor of subsequent mortality. In contrast, periprocedural MI is a marker of baseline risk, atherosclerosis burden, and procedural complexity but in most cases does not have independent prognostic significance. (Comparison of Angiomax Versus Heparin in Acute Coronary Syndromes [ACS]; NCT00093158).

KW - angioplasty

KW - myocardial infarction

KW - prognosis

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