Author(s):
Chang, CC ; Spitzer, E ; Chichareon, P ; Takahashi, K ; Modolo, R ; Kogame, N ; Tomaniak, M ; Komiyama, H ; Yap, SC ; Hoole, SP ; Gori, T ; Zaman, A ; Frey, B ; Cruz Ferreira, R ; Bertrand, OF ; Koh, TH ; Sousa, A ; Moschovitis, A ; van Geuns, RJ ; Steg, PG ; Hamm, C ; Jüni, P ; Vranckx, P ; Valgimigli, M ; Windecker, S ; Serruys, PW ; Soliman, O ; Onuma, Y
Date: 2019
Persistent ID: http://hdl.handle.net/10400.17/3423
Origin: Repositório do Centro Hospitalar de Lisboa Central, EPE
Subject(s): HSM CAR; Aged; Analysis of Variance; Aspirin / therapeutic use; Asymptomatic Diseases / mortality*; Coronary Angiography / methods; Drug Therapy, Combination; Drug-Eluting Stents; Electrocardiography / methods; Female; Humans; Internationality; Kaplan-Meier Estimate; Myocardial Infarction / diagnostic imaging; Male; Middle Aged; Myocardial Infarction / mortality*; Myocardial Infarction / therapy*; Percutaneous Coronary Intervention / methods*; Percutaneous Coronary Intervention / mortality; Prognosis; Prospective Studies; Risk Assessment; Statistics, Nonparametric; Survival Analysis; Ticagrelor / therapeutic use*; Treatment Outcome
Description
Q-wave myocardial infarction (QWMI) comprises 2 entities. First, a clinically evident MI, which can occur spontaneously or be related to a coronary procedure. Second, silent MI which is incidentally detected on serial electrocardiographic (ECG) assessment. The prevalence of silent MI after percutaneous coronary intervention (PCI) in the drug-eluting stent era has not been fully investigated. The GLOBAL LEADERS is an all-comers multicenter trial which randomized 15,991 patients who underwent PCI to 2 antiplatelet treatment strategies. The primary end point was a composite of all-cause death or nonfatal new QWMI at 2-years follow-up. ECGs were collected at discharge, 3-month and 2-year visits, and analyzed by an independent ECG core laboratory following the Minnesota code. All new QWMI were further reviewed by a blinded independent cardiologist to identify a potential clinical correlate by reviewing clinical information. Of 15,968 participants, ECG information was complete in 14,829 (92.9%) at 2 years. A new QWMI was confirmed in 186 (1.16%) patients. Transient new Q-waves were observed in 28.5% (53 of 186) of them during the follow-up. The majority of new QWMI (78%, 146 of 186) were classified as silent MI due to the absence of a clinical correlate. Silent MI accounted for 22.1% (146 of 660) of all MI events. The prevalence of silent MI did not differ significantly between treatment strategies (experimental vs reference: 0.88% vs 0.98%, p = 0.5027). In conclusion, we document the prevalence of silent MI in an all-comers population undergoing PCI in this large-scale randomized trial.
