The Incidence and Short-Term Outcomes of Periprocedural Myocardial Infarction Following Cardiac Surgery Across Two International Definitions Using the High-Sensitivity Troponin Assay - European Medical Journal

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The Incidence and Short-Term Outcomes of Periprocedural Myocardial Infarction Following Cardiac Surgery Across Two International Definitions Using the High-Sensitivity Troponin Assay

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Interventional Cardiology
EMJ Interventional Cardiology 9.1 2021 Feature Image
Authors:
Jonathan Hinton,1,2 Maclyn Augustine,1,2 Lavinia Gabara,1,2 Mark Mariathas,1,2 Rick Allan,3 Florina Borca,4 Zoe Nicholas,1 John Ikwoube,1 Neil Gillett,3 Chun Shing Kwok,5 Paul Cook,3 Michael PW Grocott,2,6 Mamas Mamas,5,7 *Nick Curzen1,2

1. Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, UK
2. Faculty of Medicine, University of Southampton, Southampton, UK
3. Department of Biochemistry, University Hospital Southampton NHS Foundation Trust, Southampton, UK
4. NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
5. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
6. Anaesthesia and Critical Care Group, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
7. Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
*Correspondence to [email protected]

Disclosure:

The high-sensitivity troponin assays used in this study were provided by Beckman Coulter (Beckman Coulter Inc., Brea, California, USA). The authors have declared no conflicts of interest.

Citation:
EMJ Int Cardiol. ;9[1]:25-27. Abstract Review No. AR1.
Keywords:
Cardiothoracic surgery, coronary artery bypass graft (CABG), high-sensitivity troponin (hs-cTn), myocardial infarction.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

BACKGROUND AND AIMS

There are currently two guideline-recommended diagnostic criteria in use to define a periprocedural myocardial infarction (PPMI) following coronary artery bypass grafting (CABG): the 4th Universal Definition of Myocardial Infarction (UDMI) and the Society of Cardiovascular Angiography and Interventions (SCAI).1,2 Understanding the merits of these definitions has become essential when interpreting the results of trials evaluating the outcomes of CABG. Despite the availability of modern biomarkers, there are as yet no studies comparing the frequency and outcomes of PPMI across these two definitions using high-sensitivity troponin (hs-cTn) assays. These criteria specifically state that a patient must have had CABG in order for a diagnosis of PPMI to be made but this leaves uncertainty as to the diagnosis in patients undergoing non-CABG cardiac surgery. The aim of this study was to describe the frequency, associations, and outcomes of PPMI when applying the SCAI and UDMI definitions using a hs-cTn assay to those patients undergoing CABG and those undergoing other cardiac surgery.

MATERIALS AND METHODS

All patients admitted to cardiothoracic critical care following open cardiac surgery over a 6-month time frame were included, except for those who had a clinically diagnosed Type 1 myocardial infarction. Testing for hs-cTnI was performed on admission and every day for 48 hours, regardless of whether the supervising team felt there was a clinical indication for testing. The results were nested and not revealed to patients or clinicians unless they were requested as part of routine care. After the two PPMI definitions were applied to patients who had undergone CABG, they were also then applied to patients who did not undergo CABG.

RESULTS

The study included 245 patients with at least one CABG, of whom 20.4% met criteria for UDMI PPMI and 87.6% for SCAI PPMI (Figure 1). There was no association between PPMI and length of stay or death in critical care regardless of the definition used. There were 243 patients included who did not have CABG in the study, of whom 11.1% met the criteria for UDMI PPMI and 85.2% for SCAI criteria. Again, there was no association between PPMI (regardless of definition) and length of stay or death in critical care.

Figure 1: The frequency of periprocedural myocardial infarction depending on the definition used and whether the patient had coronary artery bypass grafts or not.
MI: myocardial infarction; SCAI: Society of Cardiovascular Angiography and Interventions; UDMI: 4th Universal Definition of Myocardial Infarction.

CONCLUSION

The high frequency of PPMI using the SCAI criteria raises concerns about the validity of this definition in the era of hs-cTn assays. Longer term data are required to assess the relevance of a diagnosis of PPMI made using hs-cTn assays. The data suggest that separate PPMI criteria should be considered for patients that do not undergo CABG in future iterations of guidelines.

References
Thygesen K et al.; ESC Scientific Document Group. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-69. Moussa ID et al. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI). J Am Coll Cardiol. 2013;62(17):1563-70.

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