title: Frequency, causes, predictors, and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention.
abstract: OBJECTIVE
  Peri-procedural myocardial infarction (MI) is a not infrequent complication of percutaneous coronary intervention (PCI), but conflicting information exists regarding incidence and prognostic impact of this event. We investigated frequency, causes, predictors, and clinical relevance of peri-procedural MI, using a large database.
  
  
  RESULTS
  We pooled individual patient-level data from 11 PCI studies in which peri-procedural creatine kinase-MB mass was routinely measured and mortality data were prospectively collected. Among 23 604 patients from 11 studies, 1677 {7.1% [95% confidence interval (CI) 6.8-7.5%]} had peri-procedural MI. The most common mechanism of peri-procedural MI was side-branch occlusion. Independent predictors of peri-procedural MI were older age, female gender, diabetes, hypertension, renal dysfunction, multivessel disease, left anterior descending artery disease, left main disease, bifurcation lesion, long lesion, drug-eluting stents, and number of stents. Follow-up varied from 1 year to 5 years. In a crude analysis, patients with peri-procedural MI had significantly a higher risk of mortality than those without peri-procedural MI [hazard ratio (HR) 1.47; 95% CI 1.24-1.74]. After adjustment for baseline covariates, peri-procedural MI was associated with an increased risk of mortality (HR 1.20; 95% CI 1.04-1.39).
  
  
  CONCLUSIONS
  Among patients undergoing PCI, the occurrence of peri-procedural MI measured by CK-MB mass assay was ~7%, and more than half of cases were associated with side-branch occlusion. Several higher risk patients, lesions, and procedural characteristics were independent predictors of peri-procedural MI. Peri-procedural MI was associated with an increase in mortality.
authors: Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea.
authors: Duk-Woo
authors: DW
authors: Park
authors: Young-Hak
authors: YH
authors: Kim
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Jung-Min
authors: JM
authors: Ahn
authors: Jong-Young
authors: JY
authors: Lee
authors: Won-Jang
authors: WJ
authors: Kim
authors: Soo-Jin
authors: SJ
authors: Kang
authors: Seung-Whan
authors: SW
authors: Lee
authors: Cheol Whan
authors: CW
authors: Lee
authors: Seong-Wook
authors: SW
authors: Park
authors: Seung-Jung
authors: SJ
authors: Park
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy; D054059:Coronary Occlusion / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011446:Prospective Studies
keywords: Mortality; Myocardial infarction; Percutaneous coronary intervention