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Type 4a MI, myocardial injury associated with worse outcomes after PCI
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Among patients undergoing PCI, those with type 4a MI and myocardial injury had increased risk for a composite of death and recurrent MI, and they were more likely to have a complicated index PCI, according to a study published in Catheterization and Cardiovascular Interventions.
To evaluate outcomes and incidence linked to periprocedural MI in patients undergoing PCI and assess the association between baseline and procedural characteristics with postprocedural troponin, researchers obtained preprocedural and postprocedural troponin values of 516 patients undergoing eligible PCI at Beth Israel Deaconess Medical Center in 2013.
Xiaoyu Yang, MD, from the division of cardiovascular medicine at Beth Israel Deaconess Medical Center and Harvard Medical School, and colleagues used data from the National Cardiovascular Data Registry, electronic medical records and telephone interviews to conduct the study.
At 1 year, all-cause mortality, recurrent MI and repeat coronary revascularization were assessed.
Criteria for type 4a MI and myocardial injury as defined by the third universal definition of MI were met by 10.3% (n = 53) and 22.5% (n = 116) of patients, respectively.
Patients in the type 4a MI and myocardial injury cohorts had significantly higher incidence of stent placement, longer stent lengths and increased use of rotational atherectomy compared with the control group.
There was no association between type 4a MI and 1-year mortality, but recurrent MI was highest in the type 4a MI group (P = .03).
Compared with controls, those with type 4a MI (12% vs. 3%; P = .02) and those with myocardial injury (11% vs. 3%; P = .03) had a higher rate of the composite of death or recurrent MI, Yang and colleagues wrote.
“There is a long history of interest and controversy in defining periprocedural MI after PCI,” the researchers wrote. “The task force acknowledged that these criteria remain arbitrary; therefore, it is important to examine the incidence of type 4a MI and related outcomes in a real-world PCI cohort based on this definition.” – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.
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