Predictors of acute periprocedural myocardial injury during elective percutaneous coronary interventions

Abstract

Aim. To identify predictors of periprocedural myocardial injury (PMI) during elective percutaneous coronary intervention (PCI) and determine their association with the level of periprocedural increases in cardiac biomarkers (CB). Materials and methods. A single-center, open-label, prospective cohort study included 435 patients after elective PCI. Depending on the level of periprocedural increase in CB, patients were divided into 4 subgroups: without increase in CB; with an increase in CB ˃1 and ≤2x 99th percentile URL (minor PMI), >2x and ≤5x 99th percentile URL (moderate PMI), >5x 99th percentile URL (significant PMI). Next, the relationship between the level of periprocedural increase in CB and initial clinical and anamnestic data, concomitant therapy, indicators of laboratory and instrumental examination methods, and the results of genetic tests was analyzed. We used relative risk calculation and ROC analysis to determine the association of the level of CB elevation with predictors. A two-sided p value of <0.05 was considered statistically significant. Results. Minor PMI was associated with multifocal atherosclerosis, impaired glucose tolerance, doses and regimens of anticoagulants, antiplatelet agents, statins, saline infusion, baseline renal function and its change during the intervention, residual platelet reactivity during dual antiplatelet therapy, complexity of the index intervention, and the presence of thrombosis of previously installed stents, as well as the Met235Thr (rs699) polymorphism of the AGT gene. Moderate PMI was associated with clinical severity of the functional class of angina, previous cerebral stroke, intravenous saline infusion, complex type of target stenosis (type C), as well as baseline values of HbA1c, Lipocalin 2, Cystatin C and periprocedural increase in Lipocalin 2. Significant PMI was associated with obstructive pulmonary disease, clinical severity of the functional class of angina and stenosis of the left main coronary artery of more than 50%. Significant PMI differed in the formation factors from the group with minor PMI more significantly than from group 0, demonstrating a different direction of influence of risk factors associated with pharmacological strategies, such as the use of statins and anticoagulants, which requires a personalized approach to their prescription. Conclusion. Minor PMI is associated to a large extent with the comorbid conditions of patients and concomitant therapy, moderate PMI is associated with impaired renal function, the complexity of the index PCI, and significant PMI is associated with severe coronary lesions and the presence of inflammatory processes.