{"id":"dd73e011e9af","type":"article","url":"https://hartvaat.nl/2019/06/21/impact-van-groot-periprocedureel-mi-op-mortaliteit-na-pci-en-cabg/","title":"Impact van groot periprocedureel MI op mortaliteit na PCI en CABG","title_en":"Impact of large periprocedural myocardial infarction on mortality after percutaneous coronary intervention and coronary artery bypass grafting for left main disease: an analysis from the EXCEL trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehz113","source_url":"https://doi.org/10.1093/eurheartj/ehz113","authors":["Ori Ben-Yehuda","Shmuel Chen","Björn Redfors","Thomas McAndrew","Aaron Crowley","Ioanna Kosmidou","David E Kandzari","John D Puskas","Marie-Claude Morice","David P Taggart","Martin B Leon","Nicholas J Lembo","W Morris Brown","Charles A Simonton","Ovidiu Dressler","Arie Pieter Kappetein","Joseph F Sabik","Patrick W Serruys","Gregg W Stone"],"significance":6,"published":"2019-06-21","source_date":"2019-06-21","image":"","kennis":[],"congress":"","summary_en":"This study quantified the prognostic impact of large periprocedural MI after PCI versus CABG, showing that procedural MI severity differentially affects mortality depending on the revascularization strategy.","created":"2026-07-03T10:28:00Z","updated":"2026-07-03T13:27:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de impact van groot periprocedureel myocardinfarct op mortaliteit na PCI versus CABG. Kwantificeert het belang van periprocedurele schade.","abstract_original":"AIMS: The prognostic implications of periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) remain controversial. We examined the 3-year rates of mortality among patients with and without PMI undergoing left main coronary artery intervention randomized to PCI with everolimus-eluting stents vs. CABG in the large-scale, multicentre, prospective, randomized EXCEL trial. METHODS AND RESULTS: By protocol, PMI was defined using an identical threshold for PCI and CABG [creatinine kinase-MB (CK-MB) elevation >10× the upper reference limit (URL) within 72 h post-procedure, or >5× URL with new Q-waves, angiographic vessel occlusion, or loss of myocardium on imaging]. Cox proportional hazards modelling was performed controlling for age, sex, hypertension, diabetes mellitus, left ventricular ejection fraction, SYNTAX score, and chronic obstructive pulmonary disease (COPD). A total of 1858 patients were treated as assigned by randomization. Periprocedural MI occurred in 34/935 (3.6%) of patients in the PCI group and 56/923 (6.1%) of patients in the CABG group [odds ratio 0.61, 95% confidence interval (CI) 0.40-0.93; P = 0.02]. Periprocedural MI was associated with SYNTAX score, COPD, cross-clamp duration and total procedure duration, and not using antegrade cardioplegia. By multivariable analysis, PMI was associated with cardiovascular death and all-cause death at 3 years [adjusted hazard ratio (HR) 2.63, 95% CI 1.19-5.81; P = 0.02 and adjusted HR 2.28, 95% CI 1.22-4.29; P = 0.01, respectively]. The effect of PMI was consistent for PCI and CABG for cardiovascular death (Pinteraction = 0.56) and all-cause death (Pinteraction = 0.59). Peak post-procedure CK-MB ≥10× URL strongly predicted mortality, whereas lesser degrees of myonecrosis were not associated with prognosis. CONCLUSION: In the EXCEL trial, PMI was more common after CABG than PCI, and was strongly associated with increased 3-year mortality after controlling for potential confounders. Only extensive myonecrosis (CK-MB ≥10× URL) was prognostically important."}