Definition and prediction of periprocedural myocardial infarction in elective percutaneous coronary intervention: the ALPHEUS-MI study
Abstract
BackgroundPercutaneous coronary intervention (PCI)-related myocardial infarction (MI) or injury are frequent events associated with long-term ischemic outcomes and mortality. The objective of the prespecified Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting (ALPHEUS-MI) study was to describe factors associated with periprocedural MI.MethodsWithin the trial population of 1883 patients with chronic coronary syndrome who underwent elective PCI, we analyzed periprocedural myocardial necrosis using: (1) the ALPHEUS primary end point; a combination of Academic Research Consortium (ARC) type 4a/4b MI and major myocardial injury (post-PCI troponin > 5 times the upper reference limit); (2) the ALPHEUS main secondary end point; a combination of ARC type 4a/4b MI and any myocardial injury corresponding to the fourth universal definition of MI; (3) the ARC-2/Society for Cardiovascular Angiography and Interventions definition of significant myocardial injury; and (4) the ARC-2 definition of periprocedural MI.ResultsThe primary and secondary end points of the ALPHEUS trial occurred in 35.9% and 77.2% of the patients, respectively. The ARC-2/Society for Cardiovascular Angiography and Interventions periprocedural MI occurred in 2.0% of the patients and the ARC-2 significant myocardial injury in 3.2% of the patients. With all end point definitions, event rates increased gradually with the number of high-risk features including patients’ characteristics, complexity of the coronary lesion, and the complexity of the PCI procedure. After multivariable analysis, total length of stent implanted (> 60 mm) was the only common correlate of MI or myocardial injury (adjusted odds ratio ranging between 2.2 and 6.0 for the 4 definitions).ConclusionsThe accumulation of high-risk features exposes patients to periprocedural MI or injury within all definitions. Extensive atherosclerosis, which leads to longer coronary stents, plays a major role in the occurrence of periprocedural MI or injury.Clinical trial registration: NCT02617290.
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BibTeX
@article{zeitouni2026definition,
title = {{Definition and prediction of periprocedural myocardial infarction in elective percutaneous coronary intervention: the ALPHEUS-MI study}},
author = {Michel Zeitouni and Gilles Montalescot and Vincent Roule and Paul Guedeney and Jean-Louis Georges and Anne Bellemain‐ Appaix Md and Marie Hauguel-Moreau and Hervé Le Breton and Christophe Saint-Etienne and Christophe Caussin and Jean-Jacques Montsegu and Luc Maillard and Karl Isaaz and Thomas Cuisset and Erwan Bressollette and François Schiele and Guillaume Cayla and Farzin Beygui and Grégoire Range and Zuzana Motovska and Jean-Jacques Portal and Eric Vicaut and Jean-Philippe Collet and Johanne Silvain},
journal = {Canadian Journal of Cardiology},
year = {2026},
month = sep,
doi = {10.1016/j.cjca.2026.02.023},
url = {https://hal.science/hal-05614905v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Definition and prediction of periprocedural myocardial infarction in elective percutaneous coronary intervention: the ALPHEUS-MI study
AU - Michel Zeitouni
AU - Gilles Montalescot
AU - Vincent Roule
AU - Paul Guedeney
AU - Jean-Louis Georges
AU - Anne Bellemain‐ Appaix Md
AU - Marie Hauguel-Moreau
AU - Hervé Le Breton
AU - Christophe Saint-Etienne
AU - Christophe Caussin
AU - Jean-Jacques Montsegu
AU - Luc Maillard
AU - Karl Isaaz
AU - Thomas Cuisset
AU - Erwan Bressollette
AU - François Schiele
AU - Guillaume Cayla
AU - Farzin Beygui
AU - Grégoire Range
AU - Zuzana Motovska
AU - Jean-Jacques Portal
AU - Eric Vicaut
AU - Jean-Philippe Collet
AU - Johanne Silvain
PY - 2026
DA - 2026/09/01
JO - Canadian Journal of Cardiology
DO - 10.1016/j.cjca.2026.02.023
UR - https://hal.science/hal-05614905v1
AB - BackgroundPercutaneous coronary intervention (PCI)-related myocardial infarction (MI) or injury are frequent events associated with long-term ischemic outcomes and mortality. The objective of the prespecified Assessment of Loading with the P2Y12 inhibitor ticagrelor or clopidogrel to Halt ischemic Events in patients Undergoing elective coronary Stenting (ALPHEUS-MI) study was to describe factors associated with periprocedural MI.MethodsWithin the trial population of 1883 patients with chronic coronary syndrome who underwent elective PCI, we analyzed periprocedural myocardial necrosis using: (1) the ALPHEUS primary end point; a combination of Academic Research Consortium (ARC) type 4a/4b MI and major myocardial injury (post-PCI troponin > 5 times the upper reference limit); (2) the ALPHEUS main secondary end point; a combination of ARC type 4a/4b MI and any myocardial injury corresponding to the fourth universal definition of MI; (3) the ARC-2/Society for Cardiovascular Angiography and Interventions definition of significant myocardial injury; and (4) the ARC-2 definition of periprocedural MI.ResultsThe primary and secondary end points of the ALPHEUS trial occurred in 35.9% and 77.2% of the patients, respectively. The ARC-2/Society for Cardiovascular Angiography and Interventions periprocedural MI occurred in 2.0% of the patients and the ARC-2 significant myocardial injury in 3.2% of the patients. With all end point definitions, event rates increased gradually with the number of high-risk features including patients’ characteristics, complexity of the coronary lesion, and the complexity of the PCI procedure. After multivariable analysis, total length of stent implanted (> 60 mm) was the only common correlate of MI or myocardial injury (adjusted odds ratio ranging between 2.2 and 6.0 for the 4 definitions).ConclusionsThe accumulation of high-risk features exposes patients to periprocedural MI or injury within all definitions. Extensive atherosclerosis, which leads to longer coronary stents, plays a major role in the occurrence of periprocedural MI or injury.Clinical trial registration: NCT02617290.
SN - 0828-282X
SN - 1916-7075
ER -