Incidence, predictors and clinical significance of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention

Background: Although technological and equipment innovations have given rise to delicate and safe coronary intervention procedures, periprocedural myocardial injury (PMI) is still one of the common complications. The relationship between PMI, defined by various biomarker thresholds, and clinical prognosis remains controversial. We sought to assess the determinants and prognosis of PMI in patients with stable coronary artery disease (CAD) undergoing elective percutaneous coronary intervention (PCI). Methods: Consecutive stable CAD patients with negative preoperative troponin T levels undergoing elective PCI in our hospital were enrolled from July 2017 to December 2017. PMI was defined as troponin T values >99th percentile upper reference limit (URL) within 16-24 h post-PCI. The correlation of cardiovascular events and PMI was assessed after a median follow-up of 18 months. Results: PMI occurred in 45.3% of the 1572 patients included, with 11.2% having troponin T levels elevated more than 5 times the URL after PCI. Independent risk factors for PMI were age >= 65 years, prior PCI, bifurcation lesion, stent number, and multivessel disease. During the follow-up period, patients with PMI had a higher incidence of unplanned revascularization [10.8% vs. 7.2%, adjusted hazard ratio (adHR) 1.40, 95% confidence interval (CI) 1.04-2.06; p = 0.045] and target vessel revascularization (5.8% vs. 2.7%, adHR 1.90, 95% CI 1.06-3.38; p = 0.030) than those without PMI. However, no significant impact of PMI on the risk of death and myocardial infarction was found. Conclusions: PMI defined by troponin T levels >99th percentile URL correlated with an increased risk of cardiovascular events in stable CAD patients undergoing elective PCI. (C) 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.