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document
Different cardiac biomarkers to detect peri-procedural myocardial infarction in contemporary coronary stent trials : impact on outcome reporting . OBJECTIVE To assess the differential implications of cardiac biomarker type on peri-procedural myocardial infarction ( PMI ) reporting . SETTING The Resolute 'All-Comers ' stent trial . INTERVENTIONS Blood samples for creatine kinase ( CK ) , CK-myoband ( CK-MB ) mass or cardiac troponin ( cTn ) ( optional ) were collected before and at 6 , 12 and 18 h after the assigned percutaneous coronary intervention or at discharge . PMIs were adjudicated using either the 2007 universal definition of MI ( type-4a ) or the extended historical definition of MI . PATIENTS 2121/2292 patients ( 92.5 % ) had an analysable dataset for either biomarker . 890/2121 patients ( 42 % ) presented with an acute coronary syndrome ( ACS ) . 267/890 patients ( 30 % ) were within 24 h of an ST-segment elevation MI . MAIN OUTCOME MEASURES Type-4a MI was diagnosed in 208/2121 patients ( 9.8 % ) when cTn was used ( CK-MB mass if cTn not available ) , and in 93/2121 of patients ( 4.4 % ) when CK-MB mass was used ( cTn if CK-MB mass not available ) . With the extended historical CK-based definition of MI , PMI was diagnosed in 65/2121 patients ( 3.1 % ) . Adjudication of type-4a MI in patients with an ACS was problematic with < 10 % of the potential type-4a MI being confirmed as an event , as compared with approximately 95 % in stable patients undergoing elective PCI . Type-4a MI was not associated with the subsequent hazard for cardiac mortality ( p=0.6 ) . CONCLUSIONS The percentage of adjudicated PMI events is driven by the MI-definition criteria and biomarker type . Type-4a MI may not be a reliable component of the primary composite end point in coronary stent investigations which recruit patients with ACS . TRIAL REGISTRATION NUMBER http : //www.ClinicalTrials.gov ; Unique identifier : NCT00617084 .
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Intervention_Physical
percutaneous coronary intervention
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Outcome_Physical
Type-4a MI
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Outcome_Physical
PMI
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Outcome_Physical
type-4a MI
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Outcome_Mortality
cardiac mortality
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Outcome_Physical
PMI events
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Participant_Condition
contemporary coronary stent trials :
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Participant_Age
The Resolute 'All-Comers ' stent trial .
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Participant_Condition
after the assigned percutaneous coronary intervention or at discharge .
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Participant_Condition
2121/2292 patients ( 92.5 % ) had an analysable dataset for either biomarker . 890/2121 patients
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Participant_Age
267/890 patients