Periprocedural Myocardial Infarction and Clinical Outcomes in Diffuse versus Focal Coronary Artery Disease.
Whether periprocedural myocardial infarction (PMI) differs between focal and diffuse coronary physiology in the treated vessel remains unclear.
To compare the incidence and prognostic impact of PMI after PCI for vessels with focal versus diffuse diseases defined by pullback pressure gradient (PPG).
We analyzed 855 patients undergoing PCI in the PPG Global registry. Physiological patterns of treated vessels were classified as focal or diffuse using PPG. PMI in the original registry was defined according to the Fourth Universal Definition of Myocardial Infarction (UDMI). The primary outcome of the current analysis was 1-year target vessel failure (TVF), a composite of cardiac death, spontaneous target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization.
Fourth UDMI PMI was higher in patients with diffuse compared with focal physiology in the treated vessel (9.8% vs 5.9%; p=0.048). Troponin elevation ≥70 × URL(8.5% vs 4.8%; p=0.041) and PMI with flow-limiting angiographic complications (2.0% vs 0.2%; p=0.015) occurred more frequently after PCI for vessels with diffuse disease, whereas PMI with ischemic electrocardiographic changes was infrequent and similar between groups (0.8% vs 0.7%; p=1.000). 17 TVF occurred within 1 year; only troponin elevation ≥35 × URL accompanied by angiographic complications was associated with 1-year TVF.
PMI occurred more frequently after PCI for vessels with diffuse than focal coronary physiology, particularly phenotypes with higher troponin elevation or angiographic complications. Associations with 1-year TVF were observed only for PMI phenotypes incorporating angiographic complications; however, findings should be interpreted cautiously because TVF events were sparse.
To compare the incidence and prognostic impact of PMI after PCI for vessels with focal versus diffuse diseases defined by pullback pressure gradient (PPG).
We analyzed 855 patients undergoing PCI in the PPG Global registry. Physiological patterns of treated vessels were classified as focal or diffuse using PPG. PMI in the original registry was defined according to the Fourth Universal Definition of Myocardial Infarction (UDMI). The primary outcome of the current analysis was 1-year target vessel failure (TVF), a composite of cardiac death, spontaneous target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization.
Fourth UDMI PMI was higher in patients with diffuse compared with focal physiology in the treated vessel (9.8% vs 5.9%; p=0.048). Troponin elevation ≥70 × URL(8.5% vs 4.8%; p=0.041) and PMI with flow-limiting angiographic complications (2.0% vs 0.2%; p=0.015) occurred more frequently after PCI for vessels with diffuse disease, whereas PMI with ischemic electrocardiographic changes was infrequent and similar between groups (0.8% vs 0.7%; p=1.000). 17 TVF occurred within 1 year; only troponin elevation ≥35 × URL accompanied by angiographic complications was associated with 1-year TVF.
PMI occurred more frequently after PCI for vessels with diffuse than focal coronary physiology, particularly phenotypes with higher troponin elevation or angiographic complications. Associations with 1-year TVF were observed only for PMI phenotypes incorporating angiographic complications; however, findings should be interpreted cautiously because TVF events were sparse.
Authors
Zhang Zhang, Munhoz Munhoz, Heggermont Heggermont, Vermeersch Vermeersch, Sinnaeve Sinnaeve, Ikeda Ikeda, Mizukami Mizukami, Matsumura Matsumura, Sonck Sonck, Matsuo Matsuo, Amano Amano, Ando Ando, Hada Hada, Ko Ko, Biscaglia Biscaglia, Rivero Rivero, Engstrøm Engstrøm, Leone Leone, van Nunen van Nunen, Fearon Fearon, Christiansen Christiansen, Fournier Fournier, Desta Desta, Shinke Shinke, Yong Yong, Adjedj Adjedj, Escaned Escaned, Nakayama Nakayama, Eftekhari Eftekhari, Keulards Keulards, Zimmermann Zimmermann, Korngold Korngold, Campo Campo, Bouisset Bouisset, Wilgenof Wilgenof, Berry Berry, Collison Collison, Johnson Johnson, Perera Perera, Jeremias Jeremias, Cohen Cohen, Ali Ali, Mintz Mintz, Kirtane Kirtane, McEntegart McEntegart, Popma Popma, Popma Popma, Dressler Dressler, Sandoval Sandoval, De Bruyne De Bruyne, Johnson Johnson, Collet Collet
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