Background. Percutaneous Coronary Intervention (PCI) is the most used treatment strategy for patients with coronary artery disease (CAD) undergoing revascularization. Periprocedural Myocardial Infarction (PMI) still represents a frequent complication after PCI. Complex PCI procedures carry a higher risk of adverse events. Despite several studies assessed the incidence of PMI, no data exist about the rate of PMI according to different definitions in patients undergoing complex PCI.
Aims. This study aims to evaluate the incidence of PMI in patients with chronic coronary syndrome (CCS) undergoing PCI according to the complexity of the procedure and different definitions of PMI. Independent predictors of PMI according to the 4th Universal definition of myocardial infarction (UDMI) were also investigated.
Methods. 1010 patients treated with PCI from 2017 to 2021 at Federico II University Hospital, Naples, Italy were enrolled. PMI was adjudicated by full trained cardiologists. Primary outcome of interest was PMI according to the 4thUDMI. Secondary outcomes of interest were PMI rates according to different definitions available in literature and myocardial injury according to 4th UDMI and Academic Research Consortium -2 (ARC-2).
Results. Of the 1010 patients, 226 underwent Complex PCI (22.4%). The incidence of the primary outcome was significantly higher in complex PCI group compared with non-complex PCI (26.5% vs 14.5%, p<0.001). After multivariate adjustment, complex PCI (OR 1.54, 95% CI: 1.04-2.27 p= 0.031), presence of calcified lesions (OR 2.05, 95% CI: 1.38-3.03 p<0.001) and multivessel disease (OR 2.94, 95% CI: 1.76-4.89 p<0.001) were found to be independently associated with PMI.
Conclusions. Patients undergoing complex PCI have an increased risk of PMI. Multivessel disease, calcified lesions and complex PCI represent independent predictors of PMI.