Original Studies Periprocedural Myocardial Infarction is Associated With Increased Mortality in Patients With Coronary Artery Bifurcation Lesions After Implantation of a Drug-Eluting Stent Shao-Liang Chen, 1 * MD, FACC, Jun-Jie Zhang, 2 PhD, Fei Ye, 2 MD, Nai-Liang Tian, 1 MD, Imad Sheiban, 3 MD, FACC, Nigel Jepson, 4 MD, Chitprapai Paiboon, 5 MD, Teugh Sansoto, 6 MD, FACC, Tak W. Kwan, 7 MD, FACC, Shang-Yu Wen, 8 MD, Hai-Chang Wang, 9 MD, Tie-Ming Jiang, 10 MD, Yan Wang, 11 MD, Liang-Long Chen, 12 MD, Chun-Guang Qiu, 13 MD,, Yao-Jun Zhang, 2 PhD, Meng-Xuan Chen, 14 and Anthony De Maria, 15 MD Objectives: The present study aimed to investigate the association between periproce- dural myocardial infarction (PMI), defined by creatine kinase (CK)-MB or troponin I (TNI) level elevations >5 times the 99th percentile of the upper reference limit (URL) within 48 hr after implantation of a drug-eluting stent (DES), and one-year mortality in patients with coronary bifurcation. Background: PMI is reported to be associated with increased one-year mortality after DES implantation. However, the prevalence and association of PMI with mortality after stenting bifurcation lesions remains unclear. Methods: We prospectively followed 1,971 patients with true coronary bifurcations who underwent DES implantation as part of the multicenter DEFINITION study. These patients were grouped into categories based on PMI outcome: Non-PMI, CKMB-PMI, TNI-PMI, and CKMB/TNI-PMI. The primary endpoint was the rate of all-cause mortality at one year. Results: PMI occurred in 11.4% of patients by CKMB criteria and 41.3% 1 Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 2 Cardiology, Nanjing Heart Center, Nanjing, China 3 Cardiology, San Giovanni Battista Hospital, University of Turin, Turin, Italy 4 Cardiology, Hospital of Prince Wales, Sydney, Australia 5 Cardiology, Bangkok General Hospital, Bangkok, Thailand 6 Cardiology, Medistra Hospital, University of Indonesia Medi- cal School, Indonesia 7 Cardiology, Mount Sinai Beth Israel Hospital, New York, New York 8 Cardiology, Daqing Oil General Hospital, Daqing, China 9 Cardiology, Xijing Hospital, Xi’an 4th Military Medical University, Xi’an, China 10 Cardiology, Tianjing Policemen Medical College Hospital, Tianjing, China 11 Cardiology, Xia’Men Zhongshan Hospital, Xia’men, China 12 Cardiology, Fujian Union Hospital, Fuzhou, China 13 Cardiology, Henan Provincial People’s Hospital, Zhenzhou, China 14 Cardiology, Emory College of Art and Science, Atlanta, Georgia 15 Cardiology, University California San Diego, CA, USA Contract grant sponsor: Jiangsu Special program of Medicine; Contract grant number: BL-2013001. Dr. Shao-Liang Chen is a Fellow at the Collaborative Innovation Center for Cardiovascular Disease Translational Medicine of Jiangsu Province, China Conflict of interest: The authors certify that none of the manu- script’s contents have been published previously, all of the authors have read and approved the manuscript, and any potential conflicts of interests have been fully disclosed. *Correspondence to: Dr. Shao-Liang Chen, MD., Nanjing First Hos- pital, Cardiological Department, 68 Changle Road, Nanjing 210006, China. E-mail: chmengx@126.com Received 24 October 2014; Revision accepted 7 January 2015 DOI: 10.1002/ccd.25857 Published online 29 January 2015 in Wiley Online Library (wileyonlinelibrary.com) V C 2015 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 85:696–705 (2015)