Skip to main content

Advertisement

SpringerLink
Log in

Incidence of periprocedural myocardial infarction and cardiac biomarker testing after percutaneous coronary intervention in Japan: results from a multicenter registry

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

An Erratum to this article was published on 26 May 2013

Abstract

Periprocedural myocardial infarction (pMI) is an important complication associated with percutaneous coronary intervention (PCI). However, data on the frequency of biomarker testing and the incidence of pMI remain unclear. Using the multicenter Japan Cardiovascular Database, we identified 2182 patients who underwent PCI without preprocedural cardiac biomarker elevation (silent ischemia, stable angina, or unstable angina without biomarker elevation) from September 2008 to August 2011. Of these, 550 patients (25.2 %) underwent cardiac biomarker testing within 6–24 h after PCI. The incidence of pMI was 2.7 % among all identified patients and 7.5 % among those who underwent cardiac marker testing. Of note, cardiac biomarker testing was performed more frequently than no testing in patients with a higher risk profile such as unstable angina (32.7 vs 24.7 %, P < 0.001), higher symptom scaling (28.2 vs 22.5 %, P = 0.008), urgent or emergent procedures (19.3 vs 15.0 %, P = 0.022 or 4.2 vs 1.0 %, P < 0.001, respectively), and type C lesion (31.3 vs 25.2 %, P = 0.006). Presentation with silent ischemia (odds ratio = 1.51, 95 % confidence interval (CI) 1.16–1.97) and nonemergent PCIs (odds ratio = 3.45, 95 % CI 1.79–6.67) were associated with no postprocedural cardiac biomarker testing. The real-world multicenter PCI registry in Japan revealed an incidence of 2.7 % for pMI; however, cardiac biomarkers were assessed in only 25.2 % of patients after PCI. The results suggest an underuse of postprocedural biomarker testing and room for procedural quality improvement, particularly in cases of silent ischemia and nonemergent cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Califf RM, Abdelmeguid AE, Kuntz RE, Popma JJ, Davidson CJ, Cohen EA, Kleiman NS, Mahaffey KW, Topol EJ, Pepine CJ, Lipicky RJ, Granger CB, Harrington RA, Tardiff BE, Crenshaw BS, Bauman RP, Zuckerman BD, Chaitman BR, Bittl JA, Ohman EM (1998) Myonecrosis after revascularization procedures. J Am Coll Cardiol 31(2):241–251

    Article  PubMed  CAS  Google Scholar 

  2. Herrmann J (2005) Peri-procedural myocardial injury: 2005 update. Eur Heart J 26(23):2493–2519

    Article  PubMed  Google Scholar 

  3. Porto I, Selvanayagam JB, Van Gaal WJ, Prati F, Cheng A, Channon K, Neubauer S, Banning AP (2006) Plaque volume and occurrence and location of periprocedural myocardial necrosis after percutaneous coronary intervention: insights from delayed-enhancement magnetic resonance imaging, thrombolysis in myocardial infarction myocardial perfusion grade analysis, and intravascular ultrasound. Circulation 114(7):662–669

    Article  PubMed  Google Scholar 

  4. Prasad A, Herrmann J (2011) Myocardial infarction due to percutaneous coronary intervention. N Engl J Med 364(5):453–464

    Article  PubMed  CAS  Google Scholar 

  5. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB 3rd, Morrison DA, O’Neil WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B (2006) ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update 2001 Guidelines for Percutaneous Coronary Intervention). Circulation 113(7):e166–e286

    Article  PubMed  Google Scholar 

  6. Wang TY, Peterson ED, Dai D, Anderson HV, Rao SV, Brindis RG, Roe MT (2008) Patterns of cardiac marker surveillance after elective percutaneous coronary intervention and implications for the use of periprocedural myocardial infarction as a quality metric: a report from the National Cardiovascular Data Registry (NCDR). J Am Coll Cardiol 51(21):2068–2074

    Article  PubMed  Google Scholar 

  7. Bhatt DL, Topol EJ (2005) Does creatinine kinase-MB elevation after percutaneous coronary intervention predict outcomes in 2005? Periprocedural cardiac enzyme elevation predicts adverse outcomes. Circulation 112(6):906–915 (discussion 23)

    Google Scholar 

  8. Cutlip DE, Kuntz RE (2005) Does creatinine kinase-MB elevation after percutaneous coronary intervention predict outcomes in 2005? Cardiac enzyme elevation after successful percutaneous coronary intervention is not an independent predictor of adverse outcomes. Circulation 112(6):916–922 (discussion 22)

    Google Scholar 

  9. Prasad A, Rihal CS, Lennon RJ, Singh M, Jaffe AS, Holmes DR Jr (2008) Significance of periprocedural myonecrosis on outcomes after percutaneous coronary intervention: an analysis of preintervention and postintervention troponin T levels in 5487 patients. Circ Cardiovasc Interv 1(1):10–19

    Article  PubMed  Google Scholar 

  10. Stone GW, Mehran R, Dangas G, Lansky AJ, Kornowski R, Leon MB (2001) Differential impact on survival of electrocardiographic Q-wave versus enzymatic myocardial infarction after percutaneous intervention: a device-specific analysis of 7147 patients. Circulation 104(6):642–647

    Article  PubMed  CAS  Google Scholar 

  11. Ellis SG, Chew D, Chan A, Whitlow PL, Schneider JP, Topol EJ (2002) Death following creatine kinase-MB elevation after coronary intervention: identification of an early risk period: importance of creatine kinase-MB level, completeness of revascularization, ventricular function, and probable benefit of statin therapy. Circulation 106(10):1205–1210

    Article  PubMed  CAS  Google Scholar 

  12. Novack V, Pencina M, Cohen DJ, Kleiman NS, Yen CH, Saucedo JF, Berger PB, Cutlip DE (2012) Troponin criteria for myocardial infarction after percutaneous coronary intervention. Arch Intern Med 172(6):502–508

    Article  PubMed  Google Scholar 

  13. Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, Clemmensen PM, Dellborg M, Hod H, Porela P, Underwood R, Bax JJ, Beller GA, Bonow R, Van der Wall EE, Bassand JP, Wijns W, Ferguson TB, Steg PG, Uretsky BF, Williams DO, Armstrong PW, Antman EM, Fox KA, Hamm CW, Ohman EM, Simoons ML, Poole-Wilson PA, Gurfinkel EP, Lopez-Sendon JL, Pais P, Mendis S, Zhu JR, Wallentin LC, Fernandez-Aviles F, Fox KM, Parkhomenko AN, Priori SG, Tendera M, Voipio-Pulkki LM, Vahanian A, Camm AJ, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Widimsky P, Zamorano JL, Morais J, Brener S, Harrington R, Morrow D, Lim M, Martinez-Rios MA, Steinhubl S, Levine GN, Gibler WB, Goff D, Tubaro M, Dudek D, Al-Attar N (2007) Universal definition of myocardial infarction. Circulation 116(22):2634–2653

    Article  PubMed  Google Scholar 

  14. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB 3rd, Morrison DA, O’Neill WW, Schaff HV, Whitlow PL, Williams DO, Antman EM, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B (2006) ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention). J Am Coll Cardiol 47(1):216–235

    Article  PubMed  Google Scholar 

  15. King SB 3rd, Smith SC Jr, Hirshfeld JW Jr, Jacobs AK, Morrison DA, Williams DO, Feldman TE, Kern MJ, O’Neill WW, Schaff HV, Whitlow PL, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW (2008) 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. J Am Coll Cardiol 51(2):172–209

    Article  PubMed  Google Scholar 

  16. Song YB, Lee SY, Hahn JY, Choi SH, Choi JH, Lee SH, Hong KP, Park JE, Gwon HC (2012) Complete versus incomplete revascularization for treatment of multivessel coronary artery disease in the drug-eluting stent era. Heart Vessels 27(5):433–442

    Article  PubMed  Google Scholar 

  17. Bhatt DL, Lincoff AM, Gibson CM, Stone GW, McNulty S, Montalescot G, Kleiman NS, Goodman SG, White HD, Mahaffey KW, Pollack CV Jr, Manoukian SV, Widimsky P, Chew DP, Cura F, Manukov I, Tousek F, Jafar MZ, Arneja J, Skerjanec S, Harrington RA (2009) Intravenous platelet blockade with cangrelor during PCI. N Engl J Med 361(24):2330–2341

    Article  PubMed  CAS  Google Scholar 

  18. Mandadi VR, DeVoe MC, Ambrose JA, Prakash AM, Varshneya N, Gould RB, Nguyen TH, Geagea JP, Radojevic JA, Sehhat K, Barua RS (2004) Predictors of troponin elevation after percutaneous coronary intervention. Am J Cardiol 93(6):747–750

    Article  PubMed  CAS  Google Scholar 

  19. Blankenship JC, Haldis T, Feit F, Hu T, Kleiman NS, Topol EJ, Lincoff AM (2006) Angiographic adverse events, creatine kinase-MB elevation, and ischemic end points complicating percutaneous coronary intervention (a REPLACE-2 substudy). Am J Cardiol 97(11):1591–1596

    Article  PubMed  Google Scholar 

  20. Cai Q, Skelding KA, Armstrong AT Jr, Desai D, Wood GC, Blankenship JC (2007) Predictors of periprocedural creatine kinase-myocardial band elevation complicating elective percutaneous coronary intervention. Am J Cardiol 99(5):616–620

    Article  PubMed  CAS  Google Scholar 

  21. van Gaal WJ, Ponnuthurai FA, Selvanayagam J, Testa L, Porto I, Neubauer S, Banning AP (2009) The Syntax score predicts peri-procedural myocardial necrosis during percutaneous coronary intervention. Int J Cardiol 135(1):60–65

    Article  PubMed  Google Scholar 

  22. Moscucci M, Rogers EK, Montoye C, Smith DE, Share D, O’Donnell M, Maxwell-Eward A, Meengs WL, De Franco AC, Patel K, McNamara R, McGinnity JG, Jani SM, Khanal S, Eagle KA (2006) Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions. Circulation 113(6):814–822

    Article  PubMed  Google Scholar 

  23. Matsue Y, Matsumura A, Abe M, Ono M, Seya M, Nakamura T, Iwatsuka R, Mizukami A, Setoguchi M, Nagahori W, Ohno M, Suzuki M, Hashimoto Y (2012) Prognostic implications of chronic kidney disease and anemia after percutaneous coronary intervention in acute myocardial infarction patients. Heart Vessels. doi:10.1007/s00380-011-0209-2

    Google Scholar 

Download references

Acknowledgments

This study was supported by the Grant-in-Aid for Scientific Research from SENSHIN Medical Research Foundation and Pfizer Health Research Foundation (to S.K.).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Takahide Arai, Shinsuke Yuasa, Akio Kawamura, Yuichiro Maekawa, Shun Kohsaka & Keiichi Fukuda

  2. Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Hiroaki Miyata

  3. Department of Cardiology, Saitama City Hospital, Saitama, Japan

    Shiro Ishikawa

  4. Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan

    Shigetaka Noma

  5. Department of Cardiology, Hino City Hospital, Tokyo, Japan

    Soushin Inoue

  6. Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan

    Yuji Sato

Authors
  1. Takahide Arai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinsuke Yuasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroaki Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akio Kawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuichiro Maekawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shiro Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shigetaka Noma
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Soushin Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuji Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shun Kohsaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Keiichi Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takahide Arai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arai, T., Yuasa, S., Miyata, H. et al. Incidence of periprocedural myocardial infarction and cardiac biomarker testing after percutaneous coronary intervention in Japan: results from a multicenter registry. Heart Vessels 28, 714–719 (2013). https://doi.org/10.1007/s00380-012-0314-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-012-0314-x

Keywords

Search

Navigation