P4287Impact of coronary stent length on periprocedural myocardial injury after percutaneous coronary intervention for stable coronary artery disease: from the RINC randomized controlled trial data

Abstract

Introduction: Periprocedural myocardial injury (pMI) after percutaneous coronary intervention (PCI) is an independent predictor of adverse clinical outcome. Although several studies reported the risk factors related to the incidence of pMI, the evaluation of impact of the risk factors on pMI after PCI is insufficient. Purpose: The aim of this post‐hoc study was to evaluate the impact of risk factors on pMI after PCI in the data from the RINC study: multi‐center randomized controlled trial tested the incidence of pMI after PCI in patients with stable coronary artery disease by comparing among underwent upper‐limb remote ischemic preconditioning (RIPC), continuous infusion of nicorandil and the control groups. Methods: Between 2011 and 2013, the RINC study included the patients with stable coronary artery disease who planned to undergo elective PCI were assigned to three treatments in a 1:1:1 ratio: control, nicorandil infusion, and RIPC. This study used the two data sets from the RINC study: the RIPC data set (the RIPC and control groups) and the nicorandil data set (the nicorandil and control groups). The primary outcome was the incidence of pMI after PCI, with pMI De fined as an elevated level of highly sensitive cardiac troponin T; >0.07ng/mL, or creatine kinase myocardial band (CK‐MB); >10 ng/mL and CK‐MB/creatinine kinase; >5%, either at 12 hours later or 24 hours later after PCI. We investigated the impact of risk factors related to biomarker release on pMI after PCI using logistic regression models. Results: From the RINC data, 262 patients were included in the RIPC data set, and 262 patients were included in the nicorandil data set. The incidence of pMI were 44.3% in the RIPC data set and 44.7% in the nicorandil data set. Multiple logistic regression models by stepwise regression showed that past cardiovascular event history in the RIPC data set (odds ratio 1.84, 95% confidence interval [CI] 1.08‐3.12, P=0.026) and complex coronary lesions ACC‐AHA coronary classification of type B2 and C in the nicorandil data set (odds ratio 1.89, 95% CI 1.07‐3.33, P=0.027) were independent predictors of pMI after PCI. Coronary stent length was a sole common predictor of pMI after PCI in both two data sets (odds ratio 1.39 per 10 mm increase, 95% CI 1.17‐1.65, P<0.001; odds ratio 1.31, 95% CI 1.10‐1.57, P=0.002; respectively). Discrimination of pMI after PCI by coronary stent length were assessed by c‐statistics 0.68 (95% CI 0.61‐0.75) in the RIPC data set and 0.66 (95% CI 0.59‐0.73) in the nicorandil data set. Conclusion: Longer coronary stent use in PCI for patients with stable coronary artery disease might be a significant risk factor of pMI after PCI.