# Impact van groot periprocedureel MI op mortaliteit na PCI en CABG

*geplaatst 2019-06-21 · Algemeen · European heart journal · doi 10.1093/eurheartj/ehz113 · https://hartvaat.nl/2019/06/21/impact-van-groot-periprocedureel-mi-op-mortaliteit-na-pci-en-cabg/*

Studie naar de impact van groot periprocedureel myocardinfarct op mortaliteit na PCI versus CABG. Kwantificeert het belang van periprocedurele schade.

## English: 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.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: European heart journal, https://doi.org/10.1093/eurheartj/ehz113. Bijgewerkt 2026-07-03T13:27:12Z. 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.