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
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