Differential mortality risk of postprocedural creatine kinase-MB elevation following successful versus unsuccessful stent procedures.
OBJECTIVE
This study was designed to evaluate the effect of periprocedural myocardial infarction (MI) on mortality according to success of the stent procedure.


BACKGROUND
The mortality effect of periprocedural MI relative to successful versus unsuccessful procedures has not been examined.


METHODS
All-cause mortality during the first year was evaluated prospectively among 5,850 patients from coronary stent clinical trials. Myocardial infarction was classified according to creatine kinase-MB level as type 1 (>1 but <3 times normal), type 2 (>or=3 but <or=8 times normal), or type 3 (>8 times normal or Q-wave MI). Procedures were classified as successful unless there was a final diameter stenosis >50%; final Thrombolysis In Myocardial Infarction flow grade <3; final National Heart, Lung, and Blood Institute dissection grade >or=D; repeat revascularization within 24 h; or stent thrombosis within 24 h.


RESULTS
Myocardial infarction was more frequent after unsuccessful procedures (69.6% vs. 20.4%, p < 0.001). Mortality during the first year was higher in patients with MI (2.8% vs. 1.7%, p = 0.01), but the effect was significant only for type 3 MI (4.7% vs. 1.7%, p = 0.008). Moreover, the mortality difference for any MI was confined to patients with unsuccessful procedures (13.1% vs. 0%, p = 0.03), with no significant effect among patients with otherwise successful procedures (2.1% vs. 1.7%, p > 0.20). The independent predictors of mortality were unsuccessful procedure (p < 0.001), diabetes mellitus (p = 0.001), history of prior MI (p = 0.003), multivessel disease (p = 0.006), and advancing age (p < 0.001), but not periprocedural MI.


CONCLUSIONS
The association of periprocedural MI with increased mortality during the first year following stent placement was confined to patients with unsuccessful procedures.
Jeremias
Allen
A
Harvard Clinical Research Institute, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Baim
Donald S
DS
Ho
Kalon K L
KK
Chauhan
Manish
M
Carrozza
Joseph P
JP
Cohen
David J
DJ
Popma
Jeffrey J
JJ
Kuntz
Richard E
RE
Cutlip
Donald E
DE
D000368:Aged; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D003324:Coronary Artery Disease / Q000378:metabolism / Q000401:mortality / Q000601:surgery; D003402:Creatine Kinase / Q000378:metabolism*; D052279:Creatine Kinase, MB Form; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007527:Isoenzymes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism* / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form