title: Differential impact on survival of electrocardiographic Q-wave versus enzymatic myocardial infarction after percutaneous intervention: a device-specific analysis of 7147 patients.
abstract: BACKGROUND
  The relative prognostic importance of ECG myocardial infarction (MI) after intervention compared with varying degrees of enzymatic elevation has not been characterized, and the device-specific implications of periprocedural MI are also unknown.
  
  
  RESULTS
  Serial creatine phosphokinase (CPK)-MB levels were determined after elective percutaneous intervention of 12 098 lesions in 7147 consecutive patients at a tertiary referral center. Procedural, in-hospital, and follow-up data were collected by independent research nurses, and clinical and ECG events were adjudicated by a separate committee. Stents were implanted in 50.6% of lesions, atheroablation was performed in 54.8%, and PTCA alone was performed in 9.8%. The peak periprocedural CPK-MB level was >3x the upper limit of normal (ULN) in 17.9% of patients, and Q-wave MI developed in 0.6%. By multivariate analysis, the periprocedural development of new Q waves was the most powerful independent determinant of death (2-year mortality rate, 38.3%; hazard ratio, 9.9; P<0.0001). Non-Q-wave MI with CPK-MB >8x ULN was also a strong predictor of death (2-year mortality rate, 16.3%; hazard ratio, 2.2; P<0.0001); survival was unaffected by lesser degrees of CPK-MB elevation. Though CPK-MB elevation was more common after atheroablation and stenting than PTCA, the rates of Q-wave MI and survival were device-independent.
  
  
  CONCLUSIONS
  Myonecrosis after percutaneous intervention is common in a high-risk referral population dominated by atheroablation and stent use. Large periprocedural infarctions (signified by new Q waves and CPK-MB >8xULN) are powerful determinants of death, whereas lesser degrees of CPK-MB release and specific device use do not adversely affect survival.
authors.affiliation: Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York City, NY, USA.
authors.forename: G W
authors.initials: GW
authors.lastname: Stone
authors.forename: R
authors.initials: R
authors.lastname: Mehran
authors.forename: G
authors.initials: G
authors.lastname: Dangas
authors.forename: A J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: R
authors.initials: R
authors.lastname: Kornowski
authors.forename: M B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D019992:Databases as Topic / Q000706:statistics & numerical data; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form