The prognostic impact of prevailing definitions of periprocedural myocardial infarction in patients undergoing coronary artery bypass grafting.

AIMS

Several contradictory definitions have been proposed for the diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass grafting (CABG). The aim of this study was to assess the prevalence of PMI and to identify the definition of PMI with the most relevant prognostic impact.

METHODS AND RESULTS

In this systematic review and meta-analysis, the search was conducted in thee electronic databases (MEDLINE & PubMed Central, Cochrane Library, Embase). The primary definitions of interest comprised the universal definition of myocardial infarction (UDMI; UDMI-3/4) and Society for Cardiovascular Angiography and Interventions (SCAI) definition. The primary outcomes were the prevalence of PMI and its prognostic impact, expressed in hazard ratios (HRs) and 95% confidence intervals (CIs). The frequentist framework was employed for the primary analysis, and a secondary analysis was performed under a Bayesian framework. Ten studies were included (n = 21 203 patients). The prevalence of PMI was 17.5% (95%CI 9.5-29.8%) according to SCAI, and 3.2% (95%CI 1.6-6.2%) according to UDMI-3/4. The pooled HR of the SCAI definition for freedom from all-cause mortality was 1.60 (95%CI 1.18-2.16) and the HR was 2.54 (1.62-4.00) for UDMI-3/4 (P-for-interaction = 0.097). The posterior probability of exceeding an HR of 1 was >99% for both definitions, while the probability of the UDMI-3/4 exceeding the mean HR of SCAI was 96.4%. The results were robust across sensitivity analyses.

CONCLUSION

The prevalence of PMI is markedly higher when diagnosed according to SCAI criteria in CABG patients. The UDMI criteria define PMI with the most relevant prognostic impact in CABG patients.