Prognostic Relevance of Type 4a Myocardial Infarction and Periprocedural Myocardial Injury in Patients With Non–ST-Segment–Elevation Myocardial Infarction
Authors' conclusion
Periprocedural ischemic events were frequent in patients with NSTEMI undergoing PCI with prognostic implications. A post-PCI ΔcTnI >40%, combined with an absolute postprocedural value of ≥5 times the 99th percentile upper reference limit, was identified as the optimal threshold for diagnosing prognostically relevant PMI.
Study context
- Population
- Consecutive patients with NSTEMI undergoing percutaneous coronary intervention (PCI) with stable or falling pre-PCI cardiac troponin I (cTnI), January 2017 to April 2022validation cohort n = 305
- Participants
- 1,412 patients
- Exposure
- Periprocedural myocardial injury (PMI) with type 4a myocardial infarction (MI) vs PMI without type 4a MI vs no PMI
- PMI with type 4a MIn = 240
- PMI without type 4a MIn = 288
- No PMIn = 884reference
- Outcome
- All-cause mortality
- Follow-up
- 1 year
Methodological detailsconsecutive patients, internal validation cohort
- Consecutive patients
- Internal validation cohort
Main finding
As reported in the abstract
1-year all-cause mortality
Incidence
Observational data: associations, not effects.
Secondary outcomes
MACE at 1 year
- Type 4a MI had the highest 1-year MACE rate
Optimal post-PCI ΔcTnI threshold for prognostically relevant PMI
- Optimal threshold for prognostically relevant PMI, confirmed in internal validation cohort (n = 305)
- >40%
- ΔcTnI >20% but ≤40% showed outcomes similar to no PMI
Original publication
Prognostic Relevance of Type 4a Myocardial Infarction and Periprocedural Myocardial Injury in Patients With Non–ST-Segment–Elevation Myocardial Infarction. Circulation. Published 19 February 2025. doi:10.
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