title: Periprocedural myocardial infarction is not associated with an increased risk of long-term cardiac mortality after coronary bifurcation stenting.
abstract: BACKGROUND
  Debate continues over the importance of periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI). We evaluated the prognostic significance of PMI in patients undergoing PCI for bifurcation lesions.
  
  
  METHODS
  Between January 2004 and June 2006, patients from 16 centers who received non-left main bifurcation lesion PCIs were enrolled. PMI was defined as a peak creatine kinase-myocardial band (CK-MB) ≥ 3 times the upper limit of normal after PCI. We compared long-term cardiac mortality between patients with and without PMI.
  
  
  RESULTS
  Among the 1188 patients, PMI occurred in 119 (10.0%). Left ventricular ejection fraction<50% (adjusted hazard ratio [HR]: 2.08, 95% confidence interval [CI]: 1.13-3.82, p=0.018), multi-vessel coronary artery disease (adjusted HR: 2.28, 95% CI: 1.36-3.81, p=0.002), and PCI-related acute closure in a side branch (adjusted HR: 3.34, 95% CI: 1.23-9.02, p=0.018) were the significant risk factors for PMI. During the median follow-up of 22.7 months, the unadjusted rate of long-term cardiac mortality was significantly higher in patients with PMI than in those without PMI (2.5% vs. 0.7%, p=0.026). After multivariable adjustment, the relationship between PMI and short-term (≤ 30 day) cardiac mortality was significant (adjusted HR: 12.32, 95% CI: 1.07-141.37, p=0.044). However, PMI was not an independent prognostic factor of long-term cardiac mortality (adjusted HR: 2.59, 95% CI: 0.62-10.85, p=0.20).
  
  
  CONCLUSIONS
  PMI occurs in patients with a higher prevalence of adverse cardiac risks and predicts short-term but not long-term cardiac mortality in patients undergoing bifurcation lesion PCI.
authors.affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Pil Sang
authors.initials: PS
authors.lastname: Song
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Yang
authors.forename: Gu Hyun
authors.initials: GH
authors.lastname: Kang
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Seung-Jea
authors.initials: SJ
authors.lastname: Tahk
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D057234:Preoperative Period; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome