Original article Impact of periprocedural myocardial necrosis on short term clinical outcome Yosef Haggag, Mohamed Saleh ⇑ , Mahmoud Khaled, Amr Elhadidy Critical Care Medicine Department, Cairo University, Egypt article info Article history: Received 21 January 2016 Revised 15 July 2016 Accepted 16 March 2017 Available online xxxx Keywords: Periprocedural myocardial necrosis PCI Modified Gensini score abstract Background: No reliable data whether periprocedural myocardial necrosis (PPN) has same poor prognos- tic value as periprocedural myocardial infarction (PMI) or not. We aimed to assess the impact of PPN on short term clinical outcome. Methods: 100 patients admitted with non ST elevation acute coronary syndrome and underwent PCI were enrolled. Patients were grouped according to the occurrence of PPN into 2 groups, and were fol- lowed for 3 months. Patients with PMI were excluded. Results: 30 patients (30%) had PPN and were associated with higher risks of major adverse cardiac events (MACE) during the hospital and 3 months follow up (43.3% and 66.7% vs. 12.9% and 14.3% respectively; p < 0.001). PPN was more likely to occur in older, diabetic, previously infracted, and heart failure patients (p value: <0.05), in addition to patients who had lengthy and more complex lesions (p value 0.006 and <0.001 respectively). Each unit increase in Modified Gensini Score (MGS) increased odds of procedural complications 1.2 times, (P value 0.046), which in turn increased odds of short term MACE 5.7 times, (P value 0.003). Conclusions: PPN are associated with poor short term prognosis. PPN occurs more in diabetic, heart fail- ure, infracted patients and those who have complex lesions. Ó 2017 The Egyptian College of Critical Care Physicians. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 1. Introduction The relation between percutaneous coronary intervention (PCI) and subsequent myocardial injury has been reported for many years [1]. Its incidence ranges from 10% to 40% and depends on sev- eral factors such as angiographic, procedural characteristics and the biomarker used for its detection [2]. This injury is usually related to procedural complications such as side branch occlusion, distal embolization of thrombus or plaque, poor flow, and coronary dissection [2,3]. However, periprocedural myocardial infarction (PMI) may happens after apparently uncomplicated procedures [4]. The definition of periprocedural myocardial infarction is debat- able and varies in clinical trials. The consensus definition of myocardial infarction (MI) including periprocedural myocardial infarction that was published in 2000, was any rise and fall in car- diac biomarkers above the upper limit of normal (ULN) [5]. In 2007, the American College of Cardiology (ACC) defined periprocedural myocardial infarction as an increase of biomarkers greater than 3 times ULN and considered elevations of cardiac biomarkers between 1and 3 times ULN as periprocedural myocardial necrosis (PMN) and not infarction [6]. The adjusted mortality risk at 6 months was significantly increased for periprocedural myocardial infarction, but was not increased for periprocedural myocardial necrosis (RR, 2.82; P =0.03) [7]. Another analysis from Cornell Angioplasty Registry showed that after elective PCI, troponin I elevation greater than 5 times ULN were associated with a 1.8-fold increase of long- term (2-year) mortality [8]. The importance of PMN is frequently dismissed because there is little or no evidence for an indepen- dent risk of poor prognosis from these small biomarker elevations [9]. http://dx.doi.org/10.1016/j.ejccm.2017.03.002 2090-7303/Ó 2017 The Egyptian College of Critical Care Physicians. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer review under responsibility of The Egyptian College of Critical Care Physicians. Production and hosting by Elsevier ⇑ Corresponding author. E-mail addresses: joehaggag@yahoo.com (Y. Haggag), mohamedhs138@gmail. com (M. Saleh), noricu76@yahoo.com (M. Khaled), elhadidyamr@gmail.com (A. Elhadidy). The Egyptian Journal of Critical Care Medicine xxx (2017) xxx–xxx Contents lists available at ScienceDirect The Egyptian Journal of Critical Care Medicine journal homepage: www.sciencedirect.com Please cite this article in press as: Haggag Y et al. Impact of periprocedural myocardial necrosis on short term clinical outcome. Egypt J Crit Care Med (2017), http://dx.doi.org/10.1016/j.ejccm.2017.03.002