Etiology, Frequency, and Clinical Outcomes of Myocardial Infarction After Successful Drug-Eluting Stent Implantation
Tomotaka Dohi, Akiko Maehara, Bernhard Witzenbichler, Michael J. Rinaldi, Ernest L. Mazzaferri, Peter L. Duffy, Giora Weisz, Franz-Josef Neumann, Timothy D. Henry, David A. Cox, Thomas D. Stuckey, Bruce R. Brodie
(+5 others)
2015
Circulation. Cardiovascular Interventions
D espite recent advances in medical and interventional therapies, myocardial infarction (MI) continues to be a major cause of morbidity and mortality. 1, 2 Furthermore, the ability to detect MI and its associated prognosis have evolved with the introduction of increasingly sensitive and myocardial tissue-specific cardiac biomarkers. 3, 4 6] [7] Conversely, relatively little is known about the pathogenesis, frequency, predictors, and prognostic relevance of MI that occurs after successful PCI.
more »
... , therefore, evaluated the frequency, etiologies, and long-term outcomes Background-The frequency, causes, and impact of myocardial infarction (MI) after successful percutaneous coronary intervention have not been well studied. Methods and Results-The Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) study was a prospective, multicenter registry study of 8582 patients undergoing successful drug-eluting stent implantation at 11 centers in the United States and Germany. After excluding 128 patients with periprocedural MI, we investigated the pathogenesis, frequency, and long-term consequences of non-periprocedural MI in 8454 patients. MI during 2-year follow-up developed in 263 patients (3.3%) at a median (25th and 75th percentiles) time of 318 (129, 503) days. The 263 MIs were subclassified as spontaneous MI (n=78; 29.7%), secondary or indeterminate MI (n=64; 24.3%), stent thrombosis-related MI (n=63; 24.0%), and in-stent restenosis-related MI (n=58; 22.1%). Multivariable predictors of MI included clinical and angiographic factors (acute coronary syndromes presentation, diabetes mellitus, current smoker, multivessel disease, treatment of an in-stent restenotic lesion), laboratory findings (low baseline hemoglobin and reduced creatinine clearance), antiplatelet agent-related factors (higher on-treatment platelet P2Y12 receptor reactivity and premature thienopyridine discontinuation), and not being on a statin at discharge. Patients who experienced an MI during the follow-up period had significantly greater 2-year mortality than those without MI (17.3% [42 deaths] versus 3.4% [265 deaths], P<0.001). By multivariable analysis, the adjusted hazard ratio (95% confidence interval) for subsequent mortality during follow-up was 2.17 (1.06, 4.45) in patients with versus without a non-periprocedural MI (P=0.03). Conclusions-The occurrence of a non-periprocedural MI within 2 years after successful drug-eluting stent implantation is relatively infrequent, but has numerous etiologies and is significantly associated with subsequent mortality. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
doi:10.1161/circinterventions.114.002447
pmid:26643737
fatcat:cbutgz6vpvemraantzvo7qu6we
