Herrmann J, Von Birgelen C, Haude M, Volbracht L, Malyar N, Eggebrecht H, Konorza T F M, Baumgart D, Erbel R
Department of Cardiology, University Hospital Essen, Essen, Germany.
Heart. 2002 Jun;87(6):549-53. doi: 10.1136/heart.87.6.549.
To identify the incidence and clinical significance of myocardial injury following elective stent implantation.
Prospective clinical study with 278 consecutive patients undergoing stenting of de novo coronary or saphenous vein graft lesions. Incidence of periprocedural myocardial injury was assessed by analysis of 12 lead ECG, creatine kinase (CK; upper limit of normal (ULN) 70 IU/l for women, 80 IU/l for men), and cardiac troponin T (cTnT; point of care test; threshold 0.1 ng/ml) before and 6, 12, and 24 hours after the intervention. Major adverse cardiac events (MACE: acute myocardial infarction, bypass surgery, and cardiac death) were recorded during clinical follow up (mean (SD) 7.8 (5.3) months).
Following elective stenting, the rate of a positive cTnT status was 17.3%, the rate of CK increase of 1-3x ULN 14.7%, the rate of CK increase of > 3x ULN 1.4%, and the rate of Q wave myocardial infarction 0.4%. Cardiac mortality during follow up was higher in patients with postprocedurally increased CK (7.1% v 1.3%, p = 0.01, log rank) and cTnT (9.1% v 0.9%, p < 0.001, log rank). In addition, postprocedurally increased cTnT was associated with a higher overall incidence of MACE (13.1% v 4.0%, p < 0.01, log rank) and was identified as an independent factor for MACE during follow up (hazard ratio 3.27, 95% confidence interval 1.14 to 9.41, p = 0.028).
Following elective stent implantation, a positive cTnT status identified patients at risk of a worse long term outcome. Treatment strategies have to be developed that lead to prognostic improvement by reducing periprocedural myocardial injury.
确定择期支架植入术后心肌损伤的发生率及临床意义。
对278例连续性接受冠状动脉或大隐静脉移植血管病变支架植入术的患者进行前瞻性临床研究。通过分析术前及干预后6、12和24小时的12导联心电图、肌酸激酶（CK；女性正常上限（ULN）为70 IU/l，男性为80 IU/l）以及心肌肌钙蛋白T（cTnT；即时检测；阈值0.1 ng/ml）来评估围手术期心肌损伤的发生率。在临床随访（平均（标准差）7.8（5.3）个月）期间记录主要不良心脏事件（MACE：急性心肌梗死、搭桥手术和心源性死亡）。
择期支架植入术后，cTnT阳性率为17.3%，CK升高至1 - 3倍ULN的发生率为14.7%，CK升高超过3倍ULN的发生率为1.4%，Q波心肌梗死发生率为0.4%。术后CK升高的患者随访期间心源性死亡率更高（7.1%对1.3%，p = 0.01，对数秩检验），cTnT升高的患者亦是如此（9.1%对0.9%，p < 0.001，对数秩检验）。此外，术后cTnT升高与MACE的总体发生率较高相关（13.1%对4.0%，p < 0.01，对数秩检验），并且被确定为随访期间MACE的独立因素（风险比3.27，95%置信区间1.14至9.41，p = 0.028）。
择期支架植入术后，cTnT阳性可识别出长期预后较差的风险患者。必须制定治疗策略，通过减少围手术期心肌损伤来改善预后。
