Frequency and Outcomes of Periprocedural MI in Patients With Chronic Coronary Syndromes Undergoing PCI

J Am Coll Cardiol. 2022 Feb 15;79(6):513-526. doi: 10.1016/j.jacc.2021.11.047.


Background: Definitions of periprocedural myocardial infarction (MI) differ with respect to biomarker threshold as well as ancillary criteria for myocardial ischemia and are limited in terms of validation.

Objectives: This study evaluated the frequency and impact of periprocedural MI by using various MI definitions among patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI).

Methods: Between 2010 and 2018, periprocedural MIs were assessed according to the third and fourth Universal Definition of Myocardial Infarction (UDMI), Academic Research Consortium-2 (ARC-2), and Society for Cardiovascular Angiography and Interventions (SCAI) criteria based on high-sensitivity troponin in patients with CCS undergoing PCI enrolled into the Bern PCI registry. The primary endpoint was cardiac death at 1 year.

Results: Among 4,404 patients with CCS, periprocedural MI defined by the third UDMI, fourth UDMI, ARC-2, and SCAI were observed in 18.0%, 14.9%, 2.0%, and 2.0% of patients, respectively. Among patients with periprocedural MI defined by the third UDMI, fourth UDMI, ARC-2, and SCAI, cardiac mortality at 1 year was 2.9%, 3.0%, 5.8%, and 10.0%. The ARC-2 (HR: 3.90; 95% CI: 1.54-9.93) and SCAI (HR: 7.66; 95% CI: 3.64-16.11) were more relevant compared with the third UDMI (HR: 1.76; 95% CI: 1.04-3.00) and fourth UDMI (HR: 1.93; 95% CI: 1.11-3.37) for cardiac death at 1 year.

Conclusions: Among patients with CCS undergoing PCI, periprocedural MI defined according to the ARC-2 and SCAI criteria was 7 to 9 times less frequent compared with the third and fourth UDMI. Periprocedural MI defined by using the ARC-2 and SCAI were more prognostic for cardiac death at 1 year compared with the third and fourth UDMI. (CARDIOBASE Bern PCI Registry; NCT02241291).

Keywords: chronic coronary syndrome; coronary artery disease; myocardial infarction; percutaneous coronary intervention.

MeSH terms

  • Aged
  • Biomarkers / blood
  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Myocardial Infarction / blood
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / etiology
  • Oligopeptides
  • Percutaneous Coronary Intervention*
  • Prognosis
  • Registries*
  • Retrospective Studies
  • Risk Factors
  • Syndrome
  • Troponin / blood


  • Biomarkers
  • Oligopeptides
  • Troponin
  • seryl-tryptophyl-lysyl-leucyl-prolyl-prolyl-serine

Associated data