{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:49:53Z","timestamp":1790401793286,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"24","license":[{"start":{"date-parts":[[2019,3,28]],"date-time":"2019-03-28T00:00:00Z","timestamp":1553731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"EXCEL"},{"DOI":"10.13039\/100011949","name":"Abbott Vascular","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011949","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The prognostic implications of periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) remain controversial. We examined the 3-year rates of mortality among patients with and without PMI undergoing left main coronary artery intervention randomized to PCI with everolimus-eluting stents vs. CABG in the large-scale, multicentre, prospective, randomized EXCEL trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>By protocol, PMI was defined using an identical threshold for PCI and CABG [creatinine kinase-MB (CK-MB) elevation &amp;gt;10\u00d7 the upper reference limit (URL) within 72\u2009h post-procedure, or &amp;gt;5\u00d7 URL with new Q-waves, angiographic vessel occlusion, or loss of myocardium on imaging]. Cox proportional hazards modelling was performed controlling for age, sex, hypertension, diabetes mellitus, left ventricular ejection fraction, SYNTAX score, and chronic obstructive pulmonary disease (COPD). A total of 1858 patients were treated as assigned by randomization. Periprocedural MI occurred in 34\/935 (3.6%) of patients in the PCI group and 56\/923 (6.1%) of patients in the CABG group [odds ratio 0.61, 95% confidence interval (CI) 0.40\u20130.93; P\u2009=\u20090.02]. Periprocedural MI was associated with SYNTAX score, COPD, cross-clamp duration and total procedure duration, and not using antegrade cardioplegia. By multivariable analysis, PMI was associated with cardiovascular death and all-cause death at 3\u2009years [adjusted hazard ratio (HR) 2.63, 95% CI 1.19\u20135.81; P\u2009=\u20090.02 and adjusted HR 2.28, 95% CI 1.22\u20134.29; P\u2009=\u20090.01, respectively]. The effect of PMI was consistent for PCI and CABG for cardiovascular death (P \u00a0interaction = 0.56) and all-cause death (P \u00a0interaction = 0.59). Peak post-procedure CK-MB \u226510\u00d7 URL strongly predicted mortality, whereas lesser degrees of myonecrosis were not associated with prognosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In the EXCEL trial, PMI was more common after CABG than PCI, and was strongly associated with increased 3-year mortality after controlling for potential confounders. Only extensive myonecrosis (CK-MB \u226510\u00d7 URL) was prognostically important.<\/jats:p>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehz113","type":"journal-article","created":{"date-parts":[[2019,3,6]],"date-time":"2019-03-06T21:32:12Z","timestamp":1551907932000},"page":"1930-1941","source":"Crossref","is-referenced-by-count":75,"title":["Impact of large periprocedural myocardial infarction on mortality after percutaneous coronary intervention and coronary artery bypass grafting for left main disease: an analysis from the EXCEL trial"],"prefix":"10.1093","volume":"40","author":[{"given":"Ori","family":"Ben-Yehuda","sequence":"first","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"},{"name":"Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shmuel","family":"Chen","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Redfors","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"McAndrew","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Crowley","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Kosmidou","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"},{"name":"Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E","family":"Kandzari","sequence":"additional","affiliation":[{"name":"Piedmont Heart Institute, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D","family":"Puskas","sequence":"additional","affiliation":[{"name":"Mount Sinai Heart at Mount Sinai Saint Luke\u2019s, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Claude","family":"Morice","sequence":"additional","affiliation":[{"name":"Ramsay G\u00e9n\u00e9rale de Sant\u00e9, H\u00f4pital Priv\u00e9 Jacques Cartier, Massy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David P","family":"Taggart","sequence":"additional","affiliation":[{"name":"Department Cardiac Surgery, John Radcliffe Hospital, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin B","family":"Leon","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"},{"name":"Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J","family":"Lembo","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"},{"name":"Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"W Morris","family":"Brown","sequence":"additional","affiliation":[{"name":"Piedmont Heart Institute, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A","family":"Simonton","sequence":"additional","affiliation":[{"name":"Abbott Vascular, Santa Clara, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovidiu","family":"Dressler","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arie Pieter","family":"Kappetein","sequence":"additional","affiliation":[{"name":"Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Joseph F","family":"Sabik","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W","family":"Serruys","sequence":"additional","affiliation":[{"name":"Imperial College of Science, Technology and Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg W","family":"Stone","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, USA"},{"name":"Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,3,28]]},"reference":[{"key":"2022102607534402000_ehz113-B1","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1016\/j.jacc.2012.08.001","article-title":"Third universal definition of myocardial infarction","volume":"60","author":"Thygesen","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2022102607534402000_ehz113-B2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.carrev.2012.10.006","article-title":"The prognosis of periprocedural myocardial infarction after percutaneous coronary interventions","volume":"14","author":"Zimarino","year":"2013","journal-title":"Cardiovasc Revasc Med"},{"key":"2022102607534402000_ehz113-B3","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1016\/j.jacc.2013.08.720","article-title":"Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI)","volume":"62","author":"Moussa","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2022102607534402000_ehz113-B4","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1016\/j.jcin.2016.09.015","article-title":"Periprocedural myocardial infarction: the \u201cSCAI\u201d is the limit","volume":"9","author":"Stone","year":"2016","journal-title":"JACC Cardiovasc Interv"},{"key":"2022102607534402000_ehz113-B5","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1038\/nm.3764","article-title":"An emerging consensus on cardiac regeneration","volume":"20","author":"van Berlo","year":"2014","journal-title":"Nat Med"},{"key":"2022102607534402000_ehz113-B6","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1161\/CIRCINTERVENTIONS.110.959080","article-title":"Periprocedural myocardial infarction: prevalence, prognosis, and prevention","volume":"3","author":"Lansky","year":"2010","journal-title":"Circ Cardiovasc Interv"},{"key":"2022102607534402000_ehz113-B7","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1161\/CIRCINTERVENTIONS.110.957712","article-title":"Prognostic value of isolated troponin I elevation after percutaneous coronary intervention","volume":"3","author":"Cavallini","year":"2010","journal-title":"Circ Cardiovasc Interv"},{"key":"2022102607534402000_ehz113-B8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1161\/CIRCINTERVENTIONS.108.765610","article-title":"Significance of periprocedural myonecrosis on outcomes after percutaneous coronary intervention: an analysis of preintervention and postintervention troponin T levels in 5487 patients","volume":"1","author":"Prasad","year":"2008","journal-title":"Circ Cardiovasc Interv"},{"key":"2022102607534402000_ehz113-B9","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1093\/eurheartj\/ehq393","article-title":"Peri-procedural myocardial injury during percutaneous coronary intervention: an important target for cardioprotection","volume":"32","author":"Babu","year":"2011","journal-title":"Eur Heart J"},{"key":"2022102607534402000_ehz113-B10","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1056\/NEJMra0912134","article-title":"Myocardial infarction due to percutaneous coronary intervention","volume":"364","author":"Prasad","year":"2011","journal-title":"N Engl J Med"},{"key":"2022102607534402000_ehz113-B11","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1161\/CIRCINTERVENTIONS.111.962233","article-title":"Prognostic implications of creatine kinase-MB elevation after percutaneous coronary intervention: results from the Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry","volume":"4","author":"Lindsey","year":"2011","journal-title":"Circ Cardiovasc Interv"},{"key":"2022102607534402000_ehz113-B12","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1161\/CIRCINTERVENTIONS.111.965566","article-title":"Periprocedural myocardial infarction in a randomized trial of everolimus-eluting and Paclitaxel-eluting coronary stents: frequency and impact on mortality according to historic versus universal definitions","volume":"5","author":"Pervaiz","year":"2012","journal-title":". Circ Cardiovasc Interv"},{"key":"2022102607534402000_ehz113-B13","doi-asserted-by":"crossref","first-page":"2223","DOI":"10.1056\/NEJMoa1610227","article-title":"Everolimus-eluting stents or bypass surgery for left main coronary artery disease","volume":"375","author":"Stone","year":"2016","journal-title":"N Engl J Med"},{"key":"2022102607534402000_ehz113-B14","doi-asserted-by":"crossref","first-page":"861","DOI":"10.4244\/EIJV12I7A141","article-title":"Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial","volume":"12","author":"Kappetein","year":"2016","journal-title":"EuroIntervention"},{"key":"2022102607534402000_ehz113-B15","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1056\/NEJMoa0804626","article-title":"Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease","volume":"360","author":"Serruys","year":"2009","journal-title":"N Engl J Med"},{"key":"2022102607534402000_ehz113-B16","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.jacc.2010.09.038","article-title":"Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis","volume":"57","author":"Boudriot","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2022102607534402000_ehz113-B17","doi-asserted-by":"crossref","first-page":"2344","DOI":"10.1161\/CIRCULATIONAHA.106.685313","article-title":"Clinical end points in coronary stent trials: a case for standardized definitions","volume":"115","author":"Cutlip","year":"2007","journal-title":"Circulation"},{"key":"2022102607534402000_ehz113-B18","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1056\/NEJMoa1211585","article-title":"Strategies for multivessel revascularization in patients with diabetes","volume":"367","author":"Farkouh","year":"2012","journal-title":"N Engl J Med"},{"key":"2022102607534402000_ehz113-B19","doi-asserted-by":"crossref","first-page":"703","DOI":"10.4244\/EIJV6I6A119","article-title":"Myocardial injury following coronary artery surgery versus angioplasty (MICASA): a randomised trial using biochemical markers and cardiac magnetic resonance imaging","volume":"6","author":"van Gaal","year":"2011","journal-title":"EuroIntervention"},{"key":"2022102607534402000_ehz113-B20","doi-asserted-by":"crossref","first-page":"5287","DOI":"10.1016\/j.ijcard.2013.08.013","article-title":"Incidence, correlates, and significance of abnormal cardiac enzyme rises in patients treated with surgical or percutaneous based revascularisation: a substudy from the Synergy between Percutaneous Coronary Interventions with Taxus and Cardiac Surgery (SYNTAX) Trial","volume":"168","author":"Farooq","year":"2013","journal-title":"Int J Cardiol"},{"key":"2022102607534402000_ehz113-B21","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1016\/S0735-1097(02)02538-X","article-title":"Association between CK-MB elevation after percutaneous or surgical revascularization and three-year mortality","volume":"40","author":"Brener","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2022102607534402000_ehz113-B22","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1093\/eurheartj\/eht048","article-title":"Frequency, causes, predictors, and clinical significance of peri-procedural myocardial infarction following percutaneous coronary intervention","volume":"34","author":"Park","year":"2013","journal-title":"Eur Heart J"},{"key":"2022102607534402000_ehz113-B23","doi-asserted-by":"crossref","first-page":"2220","DOI":"10.1016\/j.jcin.2016.08.005","article-title":"Determinants and prognostic significance of periprocedural myocardial injury in patients with successful percutaneous chronic total occlusion interventions","volume":"9","author":"Lee","year":"2016","journal-title":"JACC Cardiovasc Interv"},{"key":"2022102607534402000_ehz113-B24","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/j.jcin.2017.05.051","article-title":"Differential rates and clinical significance of periprocedural myocardial infarction after stenting or bypass surgery for multivessel coronary disease according to various definitions","volume":"10","author":"Cho","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"2022102607534402000_ehz113-B25","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1016\/j.jacc.2011.08.007","article-title":"2011 ACCF\/AHA\/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions","volume":"58","author":"Levine","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"2022102607534402000_ehz113-B26","doi-asserted-by":"crossref","first-page":"2743","DOI":"10.1016\/S0140-6736(16)32052-9","article-title":"Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial","volume":"388","author":"Makikallio","year":"2016","journal-title":"Lancet"},{"key":"2022102607534402000_ehz113-B27","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur Heart J"},{"key":"2022102607534402000_ehz113-B28","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1378\/chest.12-2664","article-title":"Oxidative stress in COPD","volume":"144","author":"Kirkham","year":"2013","journal-title":"Chest"},{"key":"2022102607534402000_ehz113-B29","first-page":"III105","article-title":"Retrograde coronary sinus versus aortic root perfusion with cold cardioplegia: randomized study of levels of cardiac enzymes in 40 patients","volume":"74","author":"Guiraudon","year":"1986","journal-title":"Circulation"},{"key":"2022102607534402000_ehz113-B30","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1177\/096721099300100523","article-title":"Haemodynamic evaluation of retrograde versus anterograde delivery of cardioplegic solution in aortic valve replacement","volume":"1","author":"Noyez","year":"1993","journal-title":"Cardiovasc Surg"},{"key":"2022102607534402000_ehz113-B31","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1161\/hc3101.093902","article-title":"Differential impact on survival of electrocardiographic Q-wave versus enzymatic myocardial infarction after percutaneous intervention: a device-specific analysis of 7147 patients","volume":"104","author":"Stone","year":"2001","journal-title":"Circulation"},{"key":"2022102607534402000_ehz113-B32","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1093\/eurheartj\/ehx383","article-title":"ESC Joint Working Groups on Cardiovascular Surgery and the Cellular Biology of the Heart Position Paper: perioperative myocardial injury and infarction in patients undergoing coronary artery bypass graft surgery","volume":"38","author":"Thielmann","year":"2017","journal-title":"Eur Heart J"},{"key":"2022102607534402000_ehz113-B33","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.jacc.2010.07.058","article-title":"With the \u201cuniversal definition,\u201d measurement of creatine kinase-myocardial band rather than troponin allows more accurate diagnosis of periprocedural necrosis and infarction after coronary intervention","volume":"57","author":"Lim","year":"2011","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/40\/24\/1930\/46638096\/eurheartj_40_24_1930.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/40\/24\/1930\/46638096\/eurheartj_40_24_1930.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T07:54:19Z","timestamp":1666770859000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartj\/article\/40\/24\/1930\/5421317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,28]]},"references-count":33,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2019,3,28]]},"published-print":{"date-parts":[[2019,6,21]]}},"URL":"https:\/\/doi.org\/10.1093\/eurheartj\/ehz113","relation":{},"ISSN":["0195-668X","1522-9645"],"issn-type":[{"value":"0195-668X","type":"print"},{"value":"1522-9645","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,6,21]]},"published":{"date-parts":[[2019,3,28]]}}}