Different cardiac biomarkers to detect peri-procedural myocardial infarction in contemporary coronary stent trials: impact on outcome reporting
- 21 July 2012
- Vol. 98 (19), 1424-1430
- https://doi.org/10.1136/heartjnl-2012-302267
Abstract
Objective To assess the differential implications of cardiac biomarker type on peri-procedural myocardial infarction (PMI) reporting. Setting The Resolute ‘All-Comers’ stent trial. Interventions Blood samples for creatine kinase (CK), CK-myoband (CK-MB) mass or cardiac troponin (cTn) (optional) were collected before and at 6, 12 and 18 h after the assigned percutaneous coronary intervention or at discharge. PMIs were adjudicated using either the 2007 universal definition of MI (type-4a) or the extended historical definition of MI. Patients 2121/2292 patients (92.5%) had an analysable dataset for either biomarker. 890/2121 patients (42%) presented with an acute coronary syndrome (ACS). 267/890 patients (30%) were within 24 h of an ST-segment elevation MI. Main outcome measures Type-4a MI was diagnosed in 208/2121 patients (9.8%) when cTn was used (CK-MB mass if cTn not available), and in 93/2121 of patients (4.4%) when CK-MB mass was used (cTn if CK-MB mass not available). With the extended historical CK-based definition of MI, PMI was diagnosed in 65/2121 patients (3.1%). Adjudication of type-4a MI in patients with an ACS was problematic with Conclusions The percentage of adjudicated PMI events is driven by the MI-definition criteria and biomarker type. Type-4a MI may not be a reliable component of the primary composite end point in coronary stent investigations which recruit patients with ACS. Trial registration number http://www.ClinicalTrials.gov; Unique identifier: NCT00617084.Keywords
This publication has 27 references indexed in Scilit:
- Why all the struggle about CK-MB and PCI?European Heart Journal, 2012
- The Impact of Patient and Lesion Complexity on Clinical and Angiographic Outcomes After Revascularization With Zotarolimus- and Everolimus-Eluting Stents: A Substudy of the RESOLUTE All Comers Trial (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention)Journal of the American College of Cardiology, 2011
- Evaluating the 'all-comers' design: a comparison of participants in two 'all-comers' PCI trials with non-participantsEuropean Heart Journal, 2011
- Unrestricted randomised use of two new generation drug-eluting coronary stents: 2-year patient-related versus stent-related outcomes from the RESOLUTE All Comers trialThe Lancet, 2011
- How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease?European Heart Journal, 2010
- Periprocedural myocardial injury during elective percutaneous coronary intervention: is it important and how can it be prevented?Heart, 2010
- Myocardial infarction adjudication in contemporary all-comer stent trials: balancing sensitivity and specificityEuroIntervention, 2010
- Prognostic Significance of Periprocedural Versus Spontaneously Occurring Myocardial Infarction After Percutaneous Coronary Intervention in Patients With Acute Coronary SyndromesJournal of the American College of Cardiology, 2009
- Incidence, predictors, and clinical significance of troponin-I elevation without creatine kinase elevation following percutaneous coronary interventionsThe American Journal of Cardiology, 2004
- Correlation of postpercutaneous coronary intervention creatine kinase-MB and troponin I elevation in predicting mid-term mortalityThe American Journal of Cardiology, 2004