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Periprocedural myocardial infarction following percutaneous coronary intervention

David P Faxon, MD
David R Holmes, Jr, MD
David A Morrow, MD, MPH
Section Editors
Donald Cutlip, MD
Allan S Jaffe, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Percutaneous coronary intervention (PCI) is associated with a small but significant incidence of serious procedural complications such as death, stroke, life-threatening bleeding or large myocardial infarction (MI). Periprocedural myocardial necrosis, which can range from a low-level elevation of cardiac biomarkers to a large MI, is the most common complication. (See "Periprocedural complications of percutaneous coronary intervention".)

With advances in technology, particularly the use of coronary stents, the incidence of early, major cardiac events of death and large MI (both non-ST and ST elevation MI) have fallen to less than 3 percent, even in complex multivessel PCI [1,2]. However, the frequency with which any periprocedural myocardial injury is detected has increased, especially with the development of more sensitive biomarkers of myocardial damage/necrosis.

This topic will discuss the risk factors as well as the incidence, diagnosis, prognosis, mechanisms, prevention and treatment of periprocedural MI.


Serum creatinine kinase MB fraction (CK-MB) after an uncomplicated percutaneous coronary intervention (PCI) is elevated in 1 to 38 percent of patients [3-10], and elevations more than three times the upper limit of normal (ULN), which is considered to represent an infarction large enough to be associated with short-term complications [6], in 7 to 18 percent [5,10-12]. In the American College of Cardiology-National (United States) Cardiovascular Data Registry, there were over 200,000 patients without an acute coronary syndrome or elevated baseline biomarkers who underwent PCI between January 2004 and March 2007. Of these, 8 percent had a peak CK-MB >3 X ULN.

An elevation of cardiac troponin above the upper limits of normal following PCI has been noted in as many as 50 percent of patients undergoing PCI [3,5,13,14]. Cardiac troponins are a more sensitive marker than CK-MB for minor degrees of myocardial damage and elevated values after PCI with or without stenting are more common than increases in serum CK-MB [15-18]. In an analysis from the Mayo Clinic PCI registry, approximately 20 percent of patients with normal pre-procedural CK-MB and cardiac troponin T (cTnT) values had an isolated post-procedural elevation in serum cTnT [18]. (See "Troponin testing: Clinical use".)

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Literature review current through: Nov 2017. | This topic last updated: Jul 21, 2016.
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