Risk Assessment Of Perioperative Myocardial Infarction

Objective Pathophysiology of periprocedural myocardial infarction (PMI)is a multi-factor interactions. High platelet reactivity (HPR) afterclopidogrel treatment is related to an increased risk of PMI. HPR isassociated with the CYP2C19genotype. We investigated the association ofCYP2C19genotype with the incidence of PMI in patients with coronary heartdisease undergoing elective percutaneous coronary intervention. Assessthe PMI risks in patients undergoing PCI by analysing risk factors whichmay affect PMI.Metheods A total of284patients with stable angina and non-ST elevationacute coronary syndromes (NST-MI) undergoing uneventful electivepercutaneous coronary intervention (PCI) were included. Plateletreactivity was assessed by Thrombelastograph at24h after PCI. HPR wasdefined as≤20%adenosine diphosphate induced platelet aggregation. TheCYP2C19genotype was determined using DNA microarray method. Theassociation of CYP2C19genotype with incidence of PMI was measured bymultivariate logistic regression.Result PMI was documented in83of283patients(29.3%). No significantdifferences in age, gender, BMI, smoking and else baselinecharacteristics between the2groups. Compared with patients without PMI,those with PMI were implanted more stents (2.1±0.9vs.1.5±0.6，P＜0.05) and the total length of implanted stents were longer（56vs.33，P＜0.05）. Patients with PMI had significantly lower on-clopidogrelplatelet inhibition rate compared to those without PMI (36±29.8%vs.43.9±26.4%, P=0.02). HPR was more frequently observed in patients withPMI(39.8%vs.22.0%,P=0.02). HPR, the total length of stents, thecarriage of2CYP2C19LOF alleles were the risk factors of PMI inmultivariate analysis(2.18,95%CI:1.19-4.01,P=0.02、 1.03,95%CI:1.0-1.06，P=0.007、2.8,95%CI:1.2-6.3,P=0.01).Conlusion HPR, the total length of stents, the carriage of2CYP2C19LOFalleles are associated with an increased risk for PMI.