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Type 4a myocardial infarction: Incidence, risk factors, and long‐term outcomes
Author(s) -
Yang Xiaoyu,
Tamez Hector,
Lai Carol,
Ho Kalon,
Cutlip Donald
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.26688
Subject(s) - medicine , myocardial infarction , conventional pci , percutaneous coronary intervention , cardiology , mace , incidence (geometry) , acute coronary syndrome , clinical endpoint , clinical trial , physics , optics
Objectives To assess the incidence of and outcomes related to periprocedural (Type 4a) myocardial infarction (MI) in a cohort of patients undergoing percutaneous coronary intervention (PCI) for stable coronary disease or non ST‐elevation acute coronary syndrome with stable or falling cardiac troponin levels. Background The 2012 Third Universal Definition for Type 4a MI has not been prospectively studied in routine clinical practice. Methods The study included 516 patients undergoing eligible PCI at a single institution. Data were extracted from the National Cardiovascular Data Registry, review of electronic medical records, and telephone interviews. Clinical outcomes assessed at one year included all‐cause mortality, recurrent MI, or any repeat coronary revascularization. Results Based on the Third Universal Definition of MI, 53 (10.3%) patients met criteria for Type 4a MI and 116 (22.5%) had myocardial injury. The Type 4a MI and myocardial injury groups each had significantly higher numbers of stents, longer stent lengths, and more use of rotational atherectomy than the control group. Type 4a MI was not associated with one‐year mortality. The composite endpoint of death or recurrent MI at one year was similar between the Type 4a MI and myocardial injury groups (12 vs. 11%; P > 0.05), which were both higher compared with the control group (3%; P = 0.02, 0.03). Conclusions Type 4a MI and myocardial injury were frequent, and were associated with more complicated index PCI and more frequent death or recurrent MI at one year as compared with the control group. © 2016 Wiley Periodicals, Inc.