Risk factors for periprocedural myocardial injury

Risk factors for periprocedural myocardial injury

Risk factors for periprocedural myocardial injury can be classified into patient related factors, lesion related factors and procedure related factors [1].

Patient related factors include:

1. The extent of coronary artery disease (multivessel disease increases risk 1.3 to 1.8 fold)
2. Presence of systemic atherosclerosis
3. Older age
4. Comorbidities like renal failure
5. Unstable angina
6. Pre procedural CRP elevation

The lesion related factors predicting periprocedural myocardial injury are:

1. Restenotic lesions
2. Saphenous vein graft disease
3. Eccentric lesions
4. Greater plaque burden
5. Higher thrombus burden
6. Plaque rupture
7. Presence of major side branches

Procedure related factors were:

1. Threatened or acute vascular closure
2. Distal embolisation
3. No reflow or slow reflow
4. Need for directional coronary atherectomy

In general, more complex procedure would have higher incidence of periprocedural myocardial injury.

Reference

1. Joerg Herrmann. Peri-procedural myocardial injury: 2005 update. Eur Heart J. 2005 Dec;26(23):2493-519.