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Prognostic implications of procedural vs spontaneous myocardial infarction: results from the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) registry.

Publication ,  Journal Article
Bangalore, S; Pencina, MJ; Kleiman, NS; Cohen, DJ
Published in: Am Heart J
December 2013

BACKGROUND: In randomized clinical trials, procedural myocardial infarction (MI) or spontaneous MI is often weighted equally as a component of a composite clinical end point. An underlying assumption of this approach is that procedural and spontaneous MIs have similar prognostic impact. Our aim was to evaluate the prognostic impact of procedural vs spontaneous MI in patients undergoing percutaneous coronary intervention (PCI). METHODS: We used data from the EVENT registry to examine the relative prognostic impact of procedural vs spontaneous MI. For the purposes of this study, patients undergoing initial PCI were stratified into 3 groups-no MI, procedural MI, or spontaneous MI-based on standard definitions applied at the time of the index procedure and followed for 1 year for outcomes of all-cause mortality and cardiovascular mortality. Multiple propensity score adjustment analysis was used to adjust for differences in baseline covariates among the 3 groups. RESULTS: Among 7,380 patients included in this analysis, 4,568 (62%) patients had no MI, 580 (8%) patients had procedural MI at the time of their index procedure, and 2,232 (30%) patients presented with a spontaneous MI before PCI. In unadjusted analyses, there was a graded increase in risk of 1-year mortality (1.9% vs 3.1% vs 3.9%; P < .0001) and cardiovascular death (0.5% vs 1.0% vs 1.7%; P < .0001) across the 3 groups. After adjusting for propensity scores, spontaneous MI (adjusted hazard ratio [HR] 1.62, 95% CI 1.11-2.37, P = .01) but not procedural MI (adjusted HR 1.51, 95% CI 0.89-2.54, P = .12) was independently associated with death at 12 months when compared with the no-MI group. Findings were similar when the analysis was limited to cardiovascular death (adjusted HRs 3.14 [95% CI 1.68-5.90, P < .001] and 1.74 [95% CI 0.69-4.40, P = .24], respectively). CONCLUSIONS: Among patients undergoing PCI, spontaneous but not procedural MI was independently associated with death and cardiovascular death at 1 year. These finding suggest that the prognostic impact of procedural MI may be less than that of spontaneous MI and should be considered in designing end points for future studies of coronary revascularization.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2013

Volume

166

Issue

6

Start / End Page

1027 / 1034

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Registries
  • Propensity Score
  • Prognosis
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
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ICMJE
MLA
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Bangalore, S., Pencina, M. J., Kleiman, N. S., & Cohen, D. J. (2013). Prognostic implications of procedural vs spontaneous myocardial infarction: results from the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) registry. Am Heart J, 166(6), 1027–1034. https://doi.org/10.1016/j.ahj.2013.09.008
Bangalore, Sripal, Michael J. Pencina, Neal S. Kleiman, and David J. Cohen. “Prognostic implications of procedural vs spontaneous myocardial infarction: results from the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) registry.Am Heart J 166, no. 6 (December 2013): 1027–34. https://doi.org/10.1016/j.ahj.2013.09.008.
Bangalore, Sripal, et al. “Prognostic implications of procedural vs spontaneous myocardial infarction: results from the Evaluation of Drug Eluting Stents and Ischemic Events (EVENT) registry.Am Heart J, vol. 166, no. 6, Dec. 2013, pp. 1027–34. Pubmed, doi:10.1016/j.ahj.2013.09.008.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

December 2013

Volume

166

Issue

6

Start / End Page

1027 / 1034

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Registries
  • Propensity Score
  • Prognosis
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans