title: Impact of the angiographic mechanisms underlying periprocedural myocardial infarction after drug-eluting stent implantation.
abstract: Periprocedural myocardial infarction (MI) can be induced by several angiographic mechanisms. However, there are limited data on whether these mechanisms differentially affect clinical outcomes. The purpose of our study was to investigate the impact of periprocedural MI on mortality according to the underlying angiographic mechanisms after drug-eluting stent (DES) implantation. We pooled the databases from 7 coronary stent trials using DES. Periprocedural MI was classified according to its underlying angiographic mechanisms as type 1 (due to side-branch occlusion), type 2 (due to other angiographic complications), or type 3 (without angiographically identifiable causes). Among 10,889 patients treated with DES, 768 (7.1%) experienced periprocedural MI; 463 cases (60.3%) were driven by type 1 cause, 138 (18.0%) by type 2 cause, and 167 (21.7%) by type 3 cause. Mortality rates at 2 years were higher in patients with periprocedural MI than in those without (3.5% vs 2.1%, respectively). Significant differences in mortality were observed according to the angiographic mechanisms of MI (type 1: 2.8% vs type 2: 6.1% vs type 3: 3.1%). After multivariable adjustment, type 2 MI was significantly associated with an increased risk of mortality (hazard ratio 2.65, 95% confidence interval 1.77 to 3.96), whereas type 1 and type 3 MI were not related with increased mortality. In conclusion, among patients receiving DES implantation, periprocedural MI was associated with increased mortality, and there were differential associations with mortality according to the underlying angiographic mechanisms.
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Duk-Woo
authors: DW
authors: Park
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Young-Hak
authors: YH
authors: Kim
authors: Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, Korea.
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jung-Min
authors: JM
authors: Ahn
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jong-Young
authors: JY
authors: Lee
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Won-Jang
authors: WJ
authors: Kim
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Soo-Jin
authors: SJ
authors: Kang
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Seung-Whan
authors: SW
authors: Lee
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Cheol Whan
authors: CW
authors: Lee
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Seong-Wook
authors: SW
authors: Park
authors: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Electronic address: sjpark@amc.seoul.kr.
authors: Seung-Jung
authors: SJ
authors: Park
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D057234:Preoperative Period; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors