Predictors of coronary intervention-related myocardial infarction in stable angina patients pre-treated with statins

A b s t r a c t I In nt tr ro od du uc ct ti io on n: : Peri-procedural myocardial infarction (PMI) is a frequent and prognostically important complication of percutaneous coronary intervention (PCI). This study was designed to determine the predictors of PMI in patients pre-treated with statins. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : A total of 418 stable angina pectoris patients taking statins and aspirin were included. All the patients underwent PCI. Serum concentrations of creatine kinase (CK-MB mass) and troponin I (TnI) were measured prior to and then within 16 to 24 hours after PCI. The incidence of PMI was assessed using the established criteria (≥ 3 times upper limit of normal). R Re es su ul lt ts s: : Four hundred and eighteen stable patients (63 ±10 years, 68% males) were treated by PCI. The technical success rate of PCI was 99%. The incidence of PMI based on CK-MB mass or TnI release was 12% (PMI group). There were no significant differences in baseline clinical and procedural characteristics between PMI and non-PMI groups except for the balloon inflation time (40 ±44 s vs. 26 ±27 s; p = 0.02) and the proportion of treated type C lesions (42% vs. 28%; p = 0.03). In multivariate analysis, the independent predictors of PMI were balloon inflation time (OR = 1.01; 95% CI 1.001-1.020; p = 0.02) and preprocedural level of C-reactive protein (OR = 1.38; 95% CI 1.059-1.808; p = 0.02). C Co on nc cl lu us si io on ns s: : These results suggest that C-reactive protein and balloon ischaemic time are independent predictors of PMI in stable angina patients pre-treated with statins

Increased cardiovascular mortality in patients with mechanically expandable transcatheter aortic valve and without permanent pacemaker

Introduction Use of the mechanically expandable transcatheter aortic valve (MEV) has been recently linked to increased risks of valve dysfunction and cardiovascular mortality. The risk of developing conduction disturbance with the MEV valve is well known, and the negative prognostic impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation is another consideration.Aim This study aimed to compare the mid-term survival of patients with MEV and self-expandable valves (SEV), and to examine survival of both groups according to the presence or absence of PPI.Methods This single-centre, retrospective, observational study examined data from MEV and SEV groups comprising 92 and 373 patients, respectively. The mean clinical follow-up was 2.5±1.7 years. Mortality information was obtained from the National Institutes of Health Information and Statistics.Results Baseline characteristics were comparable between the groups. The log-rank test showed higher cardiovascular mortality in the MEV group (p=0.042; the relative risk (RR) 1.594 (95% CI 1.013 to 2.508)). The Cox proportional hazards model identified MEV implantation as an independent predictor of cardiovascular mortality. The rate of PPI was twice as high in the MEV vs SEV group (33.7% vs 16.1%; p<0.001). We compared the survival of both groups according to the presence or absence of PPI and found higher mortality in the MEV group without PPI versus the SEV group without PPI (p=0.007; RR 2.156 (95% CI 1.213 to 3.831)). Survival did not differ in the groups with PPI.Conclusions A higher mid-term cardiovascular mortality rate was observed with MEV versus SEV implants. Comparing both groups according to the presence or absence of PPI, we observed a higher mortality risk in patients with MEV without PPI than in SEV without PPI. In contrast, mortality did not differ between the groups when PPI was implanted