Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn, USA.
Circ Cardiovasc Interv. 2008 Aug;1(1):10-9. doi: 10.1161/CIRCINTERVENTIONS.108.765610.
Myonecrosis after percutaneous coronary intervention (PCI) has been correlated with a worse prognosis, but controversy exists about the clinical significance and potential mechanisms for the association. The aim of this study was to evaluate the relative impact of preprocedural and postprocedural cardiac troponin T (cTnT) levels on survival rate after PCI.
We evaluated 5487 patients from the Mayo Clinic registry who required nonemergency PCI, and we examined the relationship between periprocedural cTnT levels, with the 99th percentile cutoff value used for normal (<0.01 ng/mL), and outcomes. The patients were divided into 3 groups: normal preprocedural and postprocedural cTnT levels (no myonecrosis), normal preprocedural but elevated postprocedural cTnT levels (PCI-related myonecrosis), and abnormal preprocedural cTnT. The 30-day death rates were 0.1%, 0.6%, and 2.3%, respectively, in the 3 groups. In a multivariable model, an abnormal pre-PCI cTnT level (hazard ratio 9.66 [2.30-40.57]; P=0.002), and PCI-related myonecrosis (4.71 [1.02-21.83]; P=0.048) were independent predictors of 30-day mortality. Over a median follow-up of 28 months, an abnormal pre-PCI cTnT level (hazard ratio 1.79 [1.35-2.39]; P<0.001) independently predicted death, but the occurrence of PCI-related myonecrosis did not. A postprocedural elevation in creatine kinase MB fraction was not an independent predictor of long-term risk of death (0.912 [0.70-1.19]; P=0.5).
A preprocedural cTnT level >0.01 is a powerful independent predictor of prognosis after PCI and is of greater prognostic significance than the postprocedural biomarker levels. PCI-related myonecrosis occurs frequently and predicts short-term but not long-term risk of death.
经皮冠状动脉介入治疗（PCI）后的心肌坏死与预后较差相关，但两者之间的关联的临床意义和潜在机制仍存在争议。本研究旨在评估 PCI 前和 PCI 后心脏肌钙蛋白 T（cTnT）水平对 PCI 后生存率的相对影响。
我们评估了梅奥诊所注册中心 5487 例需要非紧急 PCI 的患者，并检查了围手术期 cTnT 水平与第 99 百分位截断值（<0.01ng/mL，正常）之间的关系，并观察了结局。患者分为 3 组：PCI 前和 PCI 后 cTnT 水平正常（无心肌坏死）、PCI 前 cTnT 水平正常但 PCI 后 cTnT 水平升高（PCI 相关的心肌坏死）和 PCI 前 cTnT 水平异常。3 组的 30 天死亡率分别为 0.1%、0.6%和 2.3%。在多变量模型中，PCI 前 cTnT 水平异常（危险比 9.66[2.30-40.57]；P=0.002）和 PCI 相关的心肌坏死（4.71[1.02-21.83]；P=0.048）是 30 天死亡率的独立预测因素。在中位数为 28 个月的随访中，PCI 前 cTnT 水平异常（危险比 1.79[1.35-2.39]；P<0.001）独立预测死亡，但 PCI 相关的心肌坏死的发生并不独立预测死亡。肌酸激酶 MB 同工酶升高并不独立预测长期死亡风险（0.912[0.70-1.19]；P=0.5）。
PCI 前 cTnT 水平>0.01 是 PCI 后预后的有力独立预测因素，其预测价值大于术后生物标志物水平。PCI 相关的心肌坏死常发生，并预测短期但不预测长期死亡风险。
