1
|
Paolucci L, Mangiacapra F, Sergio S, Nusca A, Briguori C, Barbato E, Ussia GP, Grigioni F. Periprocedural myocardial infarction after percutaneous coronary intervention and long-term mortality: a meta-analysis. Eur Heart J 2024:ehae266. [PMID: 38742545 DOI: 10.1093/eurheartj/ehae266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/17/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND AND AIMS Conflicting data are available regarding the association between periprocedural myocardial infarction (PMI) and mortality following percutaneous coronary intervention. The purpose of this study was to evaluate the incidence and prognostic implication of PMI according to the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition. METHODS Studies reporting adjusted effect estimates were systematically searched. The primary outcome was all-cause death, while cardiac death was included as a secondary outcome. Studies defining PMI according to biomarker elevation without further evidence of myocardial ischaemia ('ancillary criteria') were included and reported as 'definition-like'. Data were pooled in a random-effect model. RESULTS A total of 19 studies and 109 568 patients were included. The incidence of PMI was progressively lower across the UDMI, ARC-2, and SCAI definitions. All PMI definitions were independently associated with all-cause mortality [UDMI: hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.32-1.97; I2 34%; ARC-2: HR 2.07, 95% CI 1.40-3.08, I2 0%; SCAI: HR 3.24, 95% CI 2.36-4.44, I2 78%]. Including ancillary criteria in the PMI definitions were associated with an increased prognostic performance in the UDMI but not in the SCAI definition. Data were consistent after evaluation of major sources of heterogeneity. CONCLUSIONS All currently available international definitions of PMI are associated with an increased risk of all-cause death after percutaneous coronary intervention. The magnitude of this latter association varies according to the sensitivity and prognostic relevance of each definition.
Collapse
Affiliation(s)
- Luca Paolucci
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Fabio Mangiacapra
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Sara Sergio
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
| | - Annunziata Nusca
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Rome 00128, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome 00128, Italy
| |
Collapse
|
2
|
Nakazawa M, Matsumoto H, Li D, Slomka PJ, Dey D, Cadet S, Isodono K, Irie D, Higuchi S, Tanisawa H, Ohya H, Kitamura R, Komori Y, Hondera T, Sato I, Lee HL, Christodoulou AG, Xie Y, Shinke T. Rapid three-dimensional quantification of high-intensity plaques from coronary atherosclerosis T 1-weighted characterization to predict periprocedural myocardial injury. J Cardiovasc Magn Reson 2024; 26:100999. [PMID: 38237903 PMCID: PMC11211226 DOI: 10.1016/j.jocmr.2024.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND High-intensity plaque (HIP) on magnetic resonance imaging (MRI) has been documented as a powerful predictor of periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI). Despite the recent proposal of three-dimensional HIP quantification to enhance the predictive capability, the conventional pulse sequence, which necessitates the separate acquisition of anatomical reference images, hinders accurate three-dimensional segmentation along the coronary vasculature. Coronary atherosclerosis T1-weighted characterization (CATCH) enables the simultaneous acquisition of inherently coregistered dark-blood plaque and bright-blood coronary artery images. We aimed to develop a novel HIP quantification approach using CATCH and to ascertain its superior predictive performance compared to the conventional two-dimensional assessment based on plaque-to-myocardium signal intensity ratio (PMR). METHODS In this prospective study, CATCH MRI was conducted before elective stent implantation in 137 lesions from 125 patients. On CATCH images, dedicated software automatically generated tubular three-dimensional volumes of interest on the dark-blood plaque images along the coronary vasculature, based on the precisely matched bright-blood coronary artery images, and subsequently computed PMR and HIP volume (HIPvol). Specifically, HIPvol was calculated as the volume of voxels with signal intensity exceeding that of the myocardium, weighted by their respective signal intensities. PMI was defined as post-PCI cardiac troponin-T > 5 × the upper reference limit. RESULTS The entire analysis process was completed within 3 min per lesion. PMI occurred in 44 lesions. Based on the receiver operating characteristic curve analysis, HIPvol outperformed PMR for predicting PMI (C-statistics, 0.870 [95% CI, 0.805-0.936] vs. 0.787 [95% CI, 0.706-0.868]; p = 0.001). This result was primarily driven by the higher sensitivity HIPvol offered: 0.886 (95% CI, 0.754-0.962) vs. 0.750 for PMR (95% CI, 0.597-0.868; p = 0.034). Multivariable analysis identified HIPvol as an independent predictor of PMI (odds ratio, 1.15 per 10-μL increase; 95% CI, 1.01-1.30, p = 0.035). CONCLUSIONS Our semi-automated method of analyzing coronary plaque using CATCH MRI provided rapid HIP quantification. Three-dimensional assessment using this approach had a better ability to predict PMI than conventional two-dimensional assessment.
Collapse
Affiliation(s)
- Motoki Nakazawa
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Piotr J Slomka
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sebastien Cadet
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Koji Isodono
- Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Daisuke Irie
- Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Satoshi Higuchi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroki Tanisawa
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hidefumi Ohya
- Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Ryoji Kitamura
- Department of Cardiology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Yoshiaki Komori
- MR Research & Collaboration Department, Siemens Healthcare K.K., Tokyo, Japan
| | - Tetsuichi Hondera
- Department of Radiological Technology, Showa University Hospital, Japan
| | - Ikumi Sato
- Department of Radiological Technology, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Hsu-Lei Lee
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anthony G Christodoulou
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Dan K, Nakano T, Garcia-Garcia HM. Ultrathin bioresorbable-polymer sirolimus-eluting stent affected lower periprocedural high-sensitivity cardiac troponin: a pilot study. Coron Artery Dis 2023; 34:216-217. [PMID: 36951735 DOI: 10.1097/mca.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Kazuhiro Dan
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Aichi, Japan
| | - Takayuki Nakano
- Department of Cardiovascular Medicine, Ichinomiya Nishi Hospital, Ichinomiya, Aichi, Japan
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| |
Collapse
|
4
|
Cole J, Htun N, Lew R, Freilich M, Quinn S, Layland J. Colchicine to Prevent Periprocedural Myocardial Injury in Percutaneous Coronary Intervention: The COPE-PCI Pilot Trial. Circ Cardiovasc Interv 2021; 14:e009992. [PMID: 34003667 DOI: 10.1161/circinterventions.120.009992] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Justin Cole
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.).,Peninsula Clinical School, Monash University, Frankston, Australia (J.C., N.H., J.L.)
| | - Nay Htun
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.).,Peninsula Clinical School, Monash University, Frankston, Australia (J.C., N.H., J.L.)
| | - Robert Lew
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.)
| | - Mark Freilich
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.)
| | - Stephen Quinn
- Department of Health Science and Biostatistics, Swinburne University of Technology, Hawthorn, Victoria, Australia (S.Q.)
| | - Jamie Layland
- Peninsula Heart Service, Peninsula Health, Frankston, Australia (J.C., N.H., R.L., M.F., J.L.).,Peninsula Clinical School, Monash University, Frankston, Australia (J.C., N.H., J.L.)
| |
Collapse
|
5
|
Efficacy of Sodium Tanshinone IIA Sulfonate in Patients with Non-ST Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: Results from a Multicentre, Controlled, Randomized Trial. Cardiovasc Drugs Ther 2020; 35:321-329. [PMID: 32940893 DOI: 10.1007/s10557-020-07077-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sodium tanshinone IIA sulfonate (STS) has been widely used by Chinese medicine practitioners for chronic cardiovascular diseases. However, its direct clinical efficacy in patients with acute coronary syndrome following percutaneous coronary intervention (PCI) has not been reported yet. The present trial aimed to investigate potential cardioprotection of STS in patients undergoing PCI for non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS In a randomized, double-blind, placebo-controlled trial, 372 patients with NSTE-ACS were randomly assigned to receive STS (n = 192) or saline (n = 180) for 2 days before and 3 days after PCI along with standard therapy. The primary endpoint was the composite incidence of major adverse cardiac events (MACEs), including death, non-fatal myocardial infarction, repeated revascularization of the target vessel, and stent thrombosis, within 30 days after PCI. RESULTS The 30-day MACEs occurred in 18.8% of the patients in the STS group and in 27.2% of the patients in the control group (P = 0.038); this difference was mostly driven by reduction of myocardial infarction incidence (17.2% vs. 26.7%, P = 0.027). Post-procedural elevation of troponin-I was also significantly lower in the STS group (26.56% vs. 47.78%, P < 0.001). Multivariable analysis identified STS as a predictor of decreased risk of MACE occurrence (odds ratio: 0.60, 95% confidence interval: 0.36 to 0.99; P = 0.045). CONCLUSION Addition of STS to the standard treatments recommended by the current practice guidelines in patients with NSTE-ACS undergoing PCI could reduce myocardial injury and the occurrence of short-term cardiovascular events, primarily driven by non-fatal myocardial infarction. TRIAL REGISTRATION ChiCTR-TRC-14005182.
Collapse
|
6
|
Periprocedural Myocardial Injury: Pathophysiology, Prognosis, and Prevention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1041-1052. [PMID: 32586745 DOI: 10.1016/j.carrev.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/27/2023]
Abstract
The definition and clinical implications of myocardial infarction occurring in the setting of percutaneous coronary intervention have been the subject of unresolved controversy. The definitions of periprocedural myocardial infarction (PMI) are many and have evolved over recent years. Additionally, the recent advancement of different imaging modalities has provided useful information on a patients' pre-procedural risk of myocardial infarction. Nonetheless, questions on the benefit of different approaches to prevent PMI and their practical implementation remain open. This review aims to address these questions and to provide a current and contemporary perspective.
Collapse
|