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Validation of the SCAI definition of periprocedural myocardial infarction for prediction of one-year mortality following elective percutaneous coronary interventions

Session Revascularisation in stable coronary artery disease

Speaker Doctor Konstantinos Koskinas

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic) / Chronic Coronary Syndromes (CCS)
  • Session type : Rapid Fire Abstracts

Authors : KC Koskinas (Bern,CH), G Ndrepepa (Munich,DE), L Raeber (Bern,CH), S Kufner (Munich,DE), A Karagiannis (Bern,CH), T Zanchin (Bern,CH), J Hieber (Munich,DE), L Hunziker (Bern,CH), RA Byrne (Munich,DE), D Heg (Bern,CH), S Windecker (Bern,CH), A Kastrati (Munich,DE)

Authors:
K.C. Koskinas1 , G. Ndrepepa2 , L. Raeber1 , S. Kufner2 , A. Karagiannis1 , T. Zanchin1 , J. Hieber2 , L. Hunziker1 , R.A. Byrne2 , D. Heg1 , S. Windecker1 , A. Kastrati2 , 1Bern University Hospital, Department of Cardiology - Bern - Switzerland , 2Deutsches Herzzentrum Technische Universitat, Department of Cardiology - Munich - Germany ,

Topic(s):
Stable coronary artery disease

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 1210

Background: The clinical significance of myocardial injury following percutaneous coronary interventions (PCI) remains controversial, and the magnitude of cardiac troponin (cTn) elevation portending prognostic relevance has not been clearly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked elevations of post-PCI cTn levels to define periprocedural myocardial infarction, aiming to reflect prognostically relevant myocardial injury. These consensus-based thresholds have not been validated, particularly in the current era of high-sensitivity (hs) cTn assays.

Objectives: To assess the prognostic implications of the SCAI definition of periprocedural myocardial infarction, and to explore optimal cut-offs of procedure-related hs-cTnT elevation for prediction of one-year mortality in patients with stable coronary artery disease undergoing PCI by current standards.

Methods: We evaluated 8,140 consecutive patients who underwent elective PCI at two tertiary centers with available baseline and peak post-procedural hs-cTnT measurements. SCAI criteria were defined as post-procedural hs-cTnT levels >70x the upper reference limit (URL) in patients with non-elevated baseline levels (≤1x URL pre-PCI); or incremental increase of hs-cTnT >70x URL in those with elevated baseline levels (>1x URL pre-PCI).

Results: Patients meeting the SCAI criteria (n=140; 1.7%) had higher risks of all-cause mortality (HR 5.53; 95% CI 3.37–9.09; p<0.001) and cardiac morality at one year (HR 6.31, 95% CI 3.77–10.55; p<0.001). These findings held true in multivariable analyses (adjusted HR 4.20, 95% CI 2.54–6.94 for all-cause mortality; adjusted HR 4.74, 95% CI 2.82–7.96 for cardiac mortality; p<0.001 for both). Based on Receiver Operating Characteristic (ROC) curve analysis accounting for sensitivity as well as specificity, the optimal prognostic threshold of hs-cTnT with respect to one-year mortality was 7×URL, occurring in 21% of patients. This cut-off level was associated with lower specificity (0.79 vs. 0.98) but higher sensitivity (0.34 vs. 0.08) and better overall prognostic performance compared with the SCAI threshold.

Conclusions: The SCAI definition of pericprocedural myocardial infarction, accounting for pre-procedural elevation as well as post-procedural increase of hs-cTnT, is an independent predictor of one-year mortality in patients undergoing elective PCI. This cut point is highly specific but identified only 8% of patients who died within one year. According to ROC analysis, a more broadly inclusive, substantially lower threshold of hs-cTnT (7x URL) outperformed the SCAI cut point for prediction of one-year survival.

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