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Recent definition of periprocedural MI did not improve predictive accuracy
The 2012 National Cardiovascular Database CathPCI Registry Task Force definition of MI failed to improve on the predictive accuracy of the 2007 definition, according to new research.
Investigators from a single center in Washington, D.C., cited the ongoing debate surrounding the definition of a clinically meaningful periprocedural MI as reason for the current evaluation. Two definitions of periprocedural MI were assessed for quality outcomes and clinical trial endpoints.
Eligible participants were undergoing elective PCI and had normal baseline troponin-I and creatine kinase-MB.
Two definitions of periprocedural MI were used: the 2007 Task Force (National Cardiovascular Database CathPCI Registry) definition or the updated 2012 Task Force definition.
The primary outcome measure was 1-year all-cause mortality or MI assessed by multivariable analysis.
There were 7,333 patients included. Periprocedural MI as defined by the 2007 definition accounted for 31.9% of the cohort, while 2.1% were identified by the 2012 definition.
Demographic data indicated that the cohort was aged 66 ± 11 years, 66.8% were men, 1.4 ± 0.9 stents were implanted per patient and bivalirudin (Angiomax, The Medicines Company) use rate was 84.5%.
Death or MI was observed in 5.6% of patients in the 2007 cohort and 6.6% of the 2012 cohort.
No independent association was reported for the death or MI in the 2007 definition cohort (OR=1.1; 95% CI 0.9-1.5). Similarly, the 2012 definition was not associated with the primary endpoint (OR=1.4; 95% CI 0.7-3.0).
“Only a modest correlation exists for either definition to predict death or MI, which did not improve for the 2012 definition,” the researchers concluded. They added that definitions for periprocedural MI used in cath lab quality metrics and those employed in clinical trials are insufficient in discriminating for adverse events. “While the 2012 definition drastically reduced the number of periprocedural MIs defined, it did not improve the predictive accuracy over the National Cardiovascular Database CathPCI Registry definition.”
Disclosure: The researchers report no relevant financial disclosures.