title: Prognostic Significance of Peri-procedural Myocardial Infarction in the Era of High Sensitivity Troponin: A Validation of the Joint ACCF/AHA/ESC/WHF Universal Definition of Type 4a Myocardial Infarction with High Sensitivity Troponin T.
abstract: OBJECTIVE
  This study aims to validate the joint ACCF/AHA/ESC/WHF Universal Definition of peri-procedural myocardial infarction (PMI) with high sensitivity troponin T (hsTnT).
  
  
  METHODS
  A retrospective cohort study encompassing patients admitted to our institution between May 2012 and April 2013 was performed.
  
  
  RESULTS
  630 patients underwent percutaneous coronary interventions during the study period. Among them, 459 patients met the inclusion criteria and were eligible for analyses. 76.9% of these patients were male, while the mean age was 68.6. PMI was observed in 4.3% of the patients based on the Universal Definition. The predictors of PMI were chronic kidney disease (OR: 3.0, p=0.026), family history of cardiovascular disease (OR: 2.7, p=0.043) and use of IIb/IIIa inhibitors (OR 4.2, p=0.01). MACE was reported in 4.4% of the patients at 12 months, and was significantly and independently associated with PMI (OR 7.3, p=0.003) in a multivariate model which accounted for lesion complexity, patients' baseline clinical information, dual-antiplatelet status at follow-up and various procedural characteristics. The post-procedural hsTnT was much higher in those who suffered MACE than those who did not (156 v.s. 43 ng/L, p<0.001).
  
  
  CONCLUSIONS
  PMI as defined by the current Universal Definition using hsTnT is an independent predictor of adverse clinical outcome at 12 months in patients undergoing PCI. Accordingly, PMI remains a clinically relevant factor in current practice and should be considered a key outcome measure in clinical trials and a potential target for therapy.
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia. Electronic address: kevin.liou@sesiahs.health.nsw.gov.au.
authors.forename: Kevin
authors.initials: K
authors.lastname: Liou
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia.
authors.forename: Nigel
authors.initials: N
authors.lastname: Jepson
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia.
authors.forename: Petrina
authors.initials: P
authors.lastname: Kellar
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Ng
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Isbister
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Giles
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Friedman
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Allan
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia.
authors.forename: Antony
authors.initials: A
authors.lastname: Lau
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Pitney
authors.affiliation: Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia.
authors.forename: Sze-Yuan
authors.initials: SY
authors.lastname: Ooi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis; D012189:Retrospective Studies; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T
keywords: High sensitivity troponin T; MACE; Percutaneous coronary intervention; Periprocedural myocardial infarction; Universal definition