title: Different cardiac biomarkers to detect peri-procedural myocardial infarction in contemporary coronary stent trials: impact on outcome reporting.
abstract: OBJECTIVE
  To assess the differential implications of cardiac biomarker type on peri-procedural myocardial infarction (PMI) reporting.
  
  
  METHODS
  The Resolute 'All-Comers' stent trial.
  
  
  METHODS
  Blood samples for creatine kinase (CK), CK-myoband (CK-MB) mass or cardiac troponin (cTn) (optional) were collected before and at 6, 12 and 18 h after the assigned percutaneous coronary intervention or at discharge. PMIs were adjudicated using either the 2007 universal definition of MI (type-4a) or the extended historical definition of MI.
  
  
  METHODS
  2121/2292 patients (92.5%) had an analysable dataset for either biomarker. 890/2121 patients (42%) presented with an acute coronary syndrome (ACS). 267/890 patients (30%) were within 24 h of an ST-segment elevation MI.
  
  
  METHODS
  Type-4a MI was diagnosed in 208/2121 patients (9.8%) when cTn was used (CK-MB mass if cTn not available), and in 93/2121 of patients (4.4%) when CK-MB mass was used (cTn if CK-MB mass not available). With the extended historical CK-based definition of MI, PMI was diagnosed in 65/2121 patients (3.1%). Adjudication of type-4a MI in patients with an ACS was problematic with <10% of the potential type-4a MI being confirmed as an event, as compared with approximately 95% in stable patients undergoing elective PCI. Type-4a MI was not associated with the subsequent hazard for cardiac mortality (p=0.6).
  
  
  CONCLUSIONS
  The percentage of adjudicated PMI events is driven by the MI-definition criteria and biomarker type. Type-4a MI may not be a reliable component of the primary composite end point in coronary stent investigations which recruit patients with ACS.
  
  
  BACKGROUND
  http://www.ClinicalTrials.gov; Unique identifier: NCT00617084.
authors: Department of Cardiac Intensive Care and Interventional Cardiology, Hartcentrum Hasselt, Hasselt, Belgium.
authors: Pascal
authors: P
authors: Vranckx
authors: Vasim
authors: V
authors: Farooq
authors: Scot
authors: S
authors: Garg
authors: Gerrit-Anne
authors: GA
authors: Van Es
authors: Sigmund
authors: S
authors: Silber
authors: Stephan
authors: S
authors: Windecker
authors: Gregg W
authors: GW
authors: Stone
authors: Patrick W
authors: PW
authors: Serruys
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D009336:Necrosis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form