Background and Aims Conflicting data are available regarding the association between periprocedural myocardial infarction (PMI) and mortality following percutaneous coronary intervention. The purpose of this study was to evaluate the incidence and prognostic implication of PMI according to the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition. Methods Studies reporting adjusted effect estimates were systematically searched. The primary outcome was all-cause death, while cardiac death was included as a secondary outcome. Studies defining PMI according to biomarker elevation without further evidence of myocardial ischaemia (‘ancillary criteria’) were included and reported as ‘definition-like’. Data were pooled in a random-effect model. Results A total of 19 studies and 109 568 patients were included. The incidence of PMI was progressively lower across the UDMI, ARC-2, and SCAI definitions. All PMI definitions were independently associated with all-cause mortality [UDMI: hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.32–1.97; I2 34%; ARC-2: HR 2.07, 95% CI 1.40–3.08, I2 0%; SCAI: HR 3.24, 95% CI 2.36–4.44, I2 78%]. Including ancillary criteria in the PMI definitions were associated with an increased prognostic performance in the UDMI but not in the SCAI definition. Data were consistent after evaluation of major sources of heterogeneity. Conclusions All currently available international definitions of PMI are associated with an increased risk of all-cause death after percutaneous coronary intervention. The magnitude of this latter association varies according to the sensitivity and prognostic relevance of each definition.

中文翻译：

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经皮冠状动脉介入治疗后围手术期心肌梗死和长期死亡率：一项荟萃分析

背景和目的 关于围手术期心肌梗死 (PMI) 与经皮冠状动脉介入治疗后死亡率之间的关联，存在相互矛盾的数据。本研究的目的是根据心肌梗死通用定义 (UDMI)、学术研究联盟 (ARC)-2 定义以及心血管造影和介入学会 (SCAI) 定义评估 PMI 的发生率和预后意义。方法 系统地检索了报告调整后效应估计的研究。主要结局是全因死亡，而心源性死亡被列为次要结局。根据生物标志物升高定义 PMI 且没有进一步心肌缺血证据（“辅助标准”）的研究被纳入，并报告为“类似定义”。数据汇集在随机效应模型中。结果共纳入19项研究、109 568例患者。在 UDMI、ARC-2 和 SCAI 定义中，PMI 的发生率逐渐降低。所有 PMI 定义均与全因死亡率独立相关 [UDMI：风险比 (HR) 1.61，95% 置信区间 (CI) 1.32–1.97； I2 34%； ARC-2：HR 2.07，95% CI 1.40–3.08，I2 0%； SCAI：HR 3.24，95% CI 2.36–4.44，I2 78%]。在 PMI 定义中包含辅助标准与 UDMI 中的预后表现增加相关，但在 SCAI 定义中则不然。在评估异质性的主要来源后，数据是一致的。结论 目前所有可用的 PMI 国际定义均与经皮冠状动脉介入治疗后全因死亡风险增加相关。后一种关联的程度根据每个定义的敏感性和预后相关性而变化。