title: Periprocedural myocardial infarction is associated with increased mortality in patients with coronary artery bifurcation lesions after implantation of a drug-eluting stent.
abstract: OBJECTIVE
  The present study aimed to investigate the association between periprocedural myocardial infarction (PMI), defined by creatine kinase (CK)-MB or troponin I (TNI) level elevations >5 times the 99 th percentile of the upper reference limit (URL) within 48 hr after implantation of a drug-eluting stent (DES), and one-year mortality in patients with coronary bifurcation.
  
  
  BACKGROUND
  PMI is reported to be associated with increased one-year mortality after DES implantation. However, the prevalence and association of PMI with mortality after stenting bifurcation lesions remains unclear.
  
  
  METHODS
  We prospectively followed 1,971 patients with true coronary bifurcations who underwent DES implantation as part of the multicenter DEFINITION study. These patients were grouped into categories based on PMI outcome: Non-PMI, CKMB-PMI, TNI-PMI, and CKMB/TNI-PMI. The primary endpoint was the rate of all-cause mortality at one year.
  
  
  RESULTS
  PMI occurred in 11.4% of patients by CKMB criteria and 41.3% of patients by TNI criteria. At one-year follow-up, the mortality rate was 2.3% in the entire patient population. However, mortality was significantly higher in the CKMB-PMI (6.4%) and CKMB/TNI-PMI (6.1%) groups compared to the Non-PMI (1.7%) and TNI-PMI (2.1%) groups (all P < 0.05). A 10-fold increase in TNI levels resulted in similar PMI rate (5.2%) and mortality risk (adjusted HR 2.7, 95% CI 3.0-5.2) as a fivefold increase in CKMB levels.
  
  
  CONCLUSIONS
  PMI, as defined by CKMB elevations following coronary bifurcation lesion stenting, was associated with increased one-year mortality. Additionally, to attain an equal frequency of PMI, the elevation in TNI levels needed to be twice as high as the elevation in CKMB levels.
authors: Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors: Shao-Liang
authors: SL
authors: Chen
authors: Jun-Jie
authors: JJ
authors: Zhang
authors: Fei
authors: F
authors: Ye
authors: Nai-Liang
authors: NL
authors: Tian
authors: Imad
authors: I
authors: Sheiban
authors: Nigel
authors: N
authors: Jepson
authors: Chitprapai
authors: C
authors: Paiboon
authors: Teugh
authors: T
authors: Sansoto
authors: Tak W
authors: TW
authors: Kwan
authors: Shang-Yu
authors: SY
authors: Wen
authors: Hai-Chang
authors: HC
authors: Wang
authors: Tie-Ming
authors: TM
authors: Jiang
authors: Yan
authors: Y
authors: Wang
authors: Liang-Long
authors: LL
authors: Chen
authors: Chun-Guang
authors: CG
authors: Qiu
authors: Yao-Jun
authors: YJ
authors: Zhang
authors: Meng-Xuan
authors: MX
authors: Chen
authors: Anthony
authors: A
authors: De Maria
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality*; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form
keywords: coronary bifurcation lesion; creatine kinase-MB; mortality; percutaneous coronary intervention; troponin