Evidence map›Paper›PMID 39968630›Full record

ArticleCirculation2025

Prognostic Relevance of Type 4a Myocardial Infarction and Periprocedural Myocardial Injury in Patients With Non-ST-Segment-Elevation Myocardial Infarction.

Matteo Armillotta, Luca Bergamaschi, Pasquale Paolisso, Marta Belmonte, Francesco Angeli, Angelo Sansonetti, Andrea Stefanizzi, Davide Bertolini, Francesca Bodega, Sara Amicone and 16 more

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Article in Circulation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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  6. Periprocedural Myocardial Infarction: Do We Need an Updated Definition?Journal of cardiovascular development and disease · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

26 authors.

Matteo Armillotta *Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0002-7971-8052
Luca Bergamaschi *Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0001-8186-9717
Pasquale PaolissoCardiology Unit, Sant'Andrea University Hospital, Rome, Italy (P.P.).ORCID 0000-0002-7017-778X
Marta BelmonteDepartment of Advanced Biomedical Sciences, University Federico II, Naples, Italy (M.B.).
Francesco AngeliDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0002-8732-4512
Angelo SansonettiDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0002-4565-4310
Andrea StefanizziCardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Italy (A. Sansonetti, D.B., F.B., N.S., A.I., F.P.T., D.C., O.D.I., K.R., A.R., G.G., F.S., C.M., A.F.).ORCID 0009-0000-2711-4268
Davide BertoliniDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0009-0009-2554-2512
Francesca BodegaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).
Sara AmiconeDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).
Lisa CantonDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).
Damiano FedeleDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0002-9198-2817
Nicole SumaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0009-0003-6119-8890
Andrea ImpellizzeriDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).
Francesco Pio TattiloDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0009-0008-3709-5791
Daniele CavalloDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0009-0003-0782-8660
Ornella Di IuorioDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0009-0000-6352-0490
Khrystyna RyabenkoDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0001-8254-1502
Andrea RinaldiCardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Italy (A. Sansonetti, D.B., F.B., N.S., A.I., F.P.T., D.C., O.D.I., K.R., A.R., G.G., F.S., C.M., A.F.).
Gabriele GhettiCardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Italy (A. Sansonetti, D.B., F.B., N.S., A.I., F.P.T., D.C., O.D.I., K.R., A.R., G.G., F.S., C.M., A.F.).ORCID 0000-0002-2875-5929
Francesco SaiaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0001-9969-2649
Cinzia MarrozziniCardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Italy (A. Sansonetti, D.B., F.B., N.S., A.I., F.P.T., D.C., O.D.I., K.R., A.R., G.G., F.S., C.M., A.F.).
Gianni CasellaUnit of Cardiology, Maggiore Hospital, Bologna, Italy (G.C.).ORCID 0000-0002-0701-7329
Paola RucciDivision of Hygiene and Biostatistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy (P.R.).
Alberto Foà *Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0003-1216-4478
Carmine Pizzi *Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Italy (M.A., L.B., F.A., A. Sansonetti, D.B., F.B., S.A., L.C., D.F., N.S., A.I., F.P.T., D.C., O.D.I., K.R., F.S., A.F., C.P.).ORCID 0000-0002-4048-675X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPeriprocedural myocardial injury (PMI) with or without type 4a myocardial infarction (MI) might occur in patients with non-ST-segment-elevation MI (NSTEMI) after percutaneous coronary intervention (PCI). This study investigated the incidence and prognostic relevance of these events, according to current definitions, in patients with NSTEMI undergoing PCI. The best cardiac troponin I (cTnI) threshold of PMI for prognostic stratification is also suggested.

methodsConsecutive patients with NSTEMI from January 2017 to April 2022 undergoing PCI with stable or falling pre-PCI cTnI levels were enrolled. According to the Fourth Universal Definition of Myocardial Infarction, the study population was stratified into those experiencing (1) PMI with type 4a MI, (2) PMI without type 4a MI, or (3) no PMI. Post-PCI cTnI increase >20% with an absolute postprocedural value of ≥5 times the 99th percentile upper reference limit within 48 hours after PCI was used to define PMI. The primary end point was 1-year all-cause mortality, and the secondary end point consisted of major adverse cardiovascular events at 1 year, including all-cause mortality, nonfatal reinfarction, urgent revascularization, nonfatal ischemic stroke, and hospitalization for heart failure. Internal validation was performed in patients enrolled between May 2022 and April 2023.

resultsAmong 1412 patients with NSTEMI undergoing PCI with stable or falling cTnI levels at baseline, 240 (17%) experienced PMI with type 4a MI, 288 (20.4%) experienced PMI without type 4a MI, and 884 (62.6%) experienced no PMI. PMI was associated with an increased risk of adverse clinical outcomes, with patients with type 4a MI demonstrating the highest rates of 1-year all-cause mortality and major adverse cardiovascular events. A post-PCI ΔcTnI >20% but ≤40% showed similar outcomes to patients without PMI, whereas >40% was identified as the optimal threshold for prognostically relevant PMI, confirmed in an internal validation cohort of 305 patients.

conclusionsPeriprocedural ischemic events were frequent in patients with NSTEMI undergoing PCI with prognostic implications. A post-PCI ΔcTnI >40%, combined with an absolute postprocedural value of ≥5 times the 99th percentile upper reference limit, was identified as the optimal threshold for diagnosing prognostically relevant PMI. Recognizing these events may improve risk stratification and management of patients with NSTEMI.

Indexed as

Myocardial InfarctionNon-ST Elevated Myocardial InfarctionPercutaneous Coronary InterventionAgedBiomarkersFemaleHumansIncidenceMaleMiddle AgedPrognosisRisk FactorsTroponin IBiomarkersTroponin Imyocardial infarctionnon-ST elevated myocardial infarctionpercutaneous coronary interventiontreatment outcomestroponin

Identifiers

PMID39968630
PMCPMC11913249

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.