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22-07-2016 | Interventional cardiology | News | Article

PCI for perioperative MI comes with high mortality risk

medwireNews: Percutaneous coronary intervention (PCI) has a very high mortality rate when performed after perioperative myocardial infarction (MI), with more than one in 10 patients not surviving beyond 30 days.

The highest 30-day mortality was observed among patients with ST-segment elevation myocardial infarction (STEMI), at 31.2%, compared with 8.5% among patients with non-STEMI (NSTEMI), report Samir Kapadia (Cleveland Clinic Foundation, Ohio, USA) and colleagues in the Journal of the American College of Cardiology.

The overall 30-day mortality rate of 11.3% among patients undergoing PCI “is much higher than the risk adjusted hospital mortality rates for PCI in spontaneous acute coronary syndromes of approximately 1% to 5% in the CathPCI registry”, says editorialist Harold Dauerman (University of Vermont Medical Center, Burlington, USA).

“Furthermore, nearly 1 in 3 patients undergoing PCI for perioperative STEMI were dead at 30 days; this compares to an approximate mortality rate of 5% in previous large registry studies of spontaneous STEMI leading to primary PCI”, he adds.

Underlying peripheral vascular disease, bleeding after PCI and peak troponin T level all significantly predicted 30-day post-PCI mortality, at odds ratios of 4.86, 4.33 and 1.20, respectively.

And bleeding after PCI, renal insufficiency, vascular surgery and increasing age were all significant predictors of long-term mortality after PCI, at respective hazard ratios of 2.31, 2.26, 1.48 and 1.03.

Dauerman notes that although these risk factors are “consistent with risk factors for generic PCI […] they may not fully explain the enhanced death rates for perioperative compared to spontaneous [acute] MI PCI.”

The study included 1093 patients referred for diagnostic angiography for MI who had undergone noncardiac surgery within the previous 7 days. Of these, 281 underwent PCI a median of 2 days after their initial surgery: 40 had STEMI and 241 had NSTEMI.

Vascular surgery was the most common index procedure, carried out in 29%, followed by pelvic and gastrointestinal surgeries at 14% each.

Analysis of the angiographic data showed that the left anterior descending artery was the most common culprit vessel for perioperative MI (32.1%), then the left circumflex (29.6%) and right coronary (22.1%) arteries. A further 11% of patients had either a graft occlusion or multivessel disease and just 5% had left main coronary artery occlusion.

Kapadia and co-authors conclude that their data “provide clinicians with a better understanding of coronary anatomy and outcomes in this high-risk patient population, which may help to bridge the knowledge gap on the role of PCI for these patients.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016

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