Prognostic Significance of Periprocedural Versus Spontaneously Occurring Myocardial Infarction After Percutaneous Coronary Intervention in Patients With Acute Coronary SyndromesAn Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Trial
Abhiram Prasad, MD*,
Bernard J. Gersh, MB, ChB, DPhil, MD*,
Michel E. Bertrand, MD ,
A. Michael Lincoff, MD ,
Jeffrey W. Moses, MD ,
E. Magnus Ohman, MD||,
Harvey D. White, MD¶,
Stuart J. Pocock, PhD#,
Brent T. McLaurin, MD**,
David A. Cox, MD,
Alexandra J. Lansky, MD,
Roxana Mehran, MD and
Gregg W. Stone, MD,*
* Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Hôpital Cardiologique, Lille, France
Cleveland Clinic, Cleveland, Ohio
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
|| Duke University Medical Center, Durham, North Carolina
¶ Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
# London School of Hygiene and Tropical Medicine, London, United Kingdom
** Anderson Heart, Anderson, South Carolina
Mid Carolina Cardiology, Charlotte, North Carolina
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Figure 1 30-Day Rates of Mortality, Unplanned Revascularization, and Major Bleeding Unrelated to CABG
Results are shown for patients with periprocedural myocardial infarction (MI), spontaneous MI, and no MI. CABG = coronary artery bypass grafting.
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Figure 2 Time-to-Event Curves for 1-Year Mortality
(A) Kaplan-Meier estimates of 1-year death among all patients. (B) Kaplan-Meier estimates of 1-year death among percutaneous coronary intervention (PCI) patients admitted with a diagnosis of non–ST-segment elevation myocardial infarction (MI). (C) Kaplan-Meier estimates of 1-year death among PCI patients admitted with a diagnosis of unstable angina.
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Figure 3 Time-to-Event Curves for 1-Year Mortality in Patients With and Without Stent Thrombosis
Mortality in patients with stent thrombosis was greater (p < 0.01) compared with those without, for both types of myocardial infarction (MI).
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Figure 4 Independent Predictors of 1-Year Mortality
Time-updated baseline covariate adjusted multivariate model in which periprocedural MI, spontaneously occurring MI, non-CABG major bleeding, and unplanned revascularization were entered as time-dependent covariates. Additional variables included in the model that were not independent predictors included weight, history of hyperlipidemia, hypertension, current smoking, coronary artery disease, previous PCI or CABG, thienopyridine therapy pre-intervention, heparin use pre-randomization, and treatment assignment in the trial. CK-MB = creatine kinase, myocardial band; CrCl = creatinine clearance; ECG = electrocardiogram; MI = myocardial infarction; UFH = unfractionated heparin; other abbreviations as in Figure 1.
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