Mortality After Procedural or Spontaneous Myocardial Infarction.

Spirito, Alessandro; Sartori, Samantha; Koshy, Anoop N; Feng, Yihan; Vogel, Birgit; Baber, Usman; Sweeny, Joseph; Khera, Sahil; Kini, Annapoorna S; Windecker, Stephan; Dangas, George; Sharma, Samin K; Mehran, Roxana (2024). Mortality After Procedural or Spontaneous Myocardial Infarction. Journal of the American College of Cardiology, 84(5), pp. 467-477. Elsevier 10.1016/j.jacc.2024.04.061

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BACKGROUND

It remains unclear whether procedural myocardial infarction (pMI) and spontaneous myocardial infarction (spMI) have a similar impact on prognosis.

OBJECTIVES

The aim of this study was to assess mortality after pMI and spMI.

METHODS

Patients with chronic coronary syndrome (CCS) and baseline troponin ≤1× the upper reference level (URL) or with acute spMI who underwent percutaneous coronary intervention (PCI) were included. PMI was defined as post-PCI troponin increase >1× URL in patients with CCS. SpMI comprised any acute coronary syndrome with elevated troponin. The 1-year risk of all-cause death was assessed after pMI and spMI across 3 strata of troponin elevation (>1-5×, >5-35×, and >35× URL), with CCS patients having post-PCI troponin ≤1× URL as a reference group. Conventional troponin I was measured using the Architect methodology (Abbott).

RESULTS

Among 10,707 patients undergoing PCI from 2012 to 2020, 8,515 patients presented with CCS and 2,192 with spMI. Among CCS patients, 913 (10.7%) had pMI. Troponin peaks >1-5×, >5-35×, and >35× URL were observed in 53%, 41%, and 6% of patients with pMI, and in 24%, 38%, and 37% of patients with spMI, respectively. Mortality at 1 year was higher after pMI (7.7%; adjusted HR: 4.40; 95% CI: 1.59-12.2), and spMI (8.5%; adjusted HR: 7.57; 95% CI: 5.44-10.5) with troponin peak >35× URL compared with no-MI (1.4%). Mortality was also increased after spMI with troponin peak >1-5× or >5-35× URL.

CONCLUSIONS

Mortality at 1 year was significantly increased after pMI and spMI with troponin peak >35× URL, whereas for troponin levels ≤35× only spMI had a relevant impact on mortality.

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