Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Int J Cardiol. 2013 Aug 20;167(4):1251-6. doi: 10.1016/j.ijcard.2012.03.146. Epub 2012 Apr 9.
Debate continues over the importance of periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI). We evaluated the prognostic significance of PMI in patients undergoing PCI for bifurcation lesions.
Between January 2004 and June 2006, patients from 16 centers who received non-left main bifurcation lesion PCIs were enrolled. PMI was defined as a peak creatine kinase-myocardial band (CK-MB) ≥ 3 times the upper limit of normal after PCI. We compared long-term cardiac mortality between patients with and without PMI.
Among the 1188 patients, PMI occurred in 119 (10.0%). Left ventricular ejection fraction<50% (adjusted hazard ratio [HR]: 2.08, 95% confidence interval [CI]: 1.13-3.82, p=0.018), multi-vessel coronary artery disease (adjusted HR: 2.28, 95% CI: 1.36-3.81, p=0.002), and PCI-related acute closure in a side branch (adjusted HR: 3.34, 95% CI: 1.23-9.02, p=0.018) were the significant risk factors for PMI. During the median follow-up of 22.7 months, the unadjusted rate of long-term cardiac mortality was significantly higher in patients with PMI than in those without PMI (2.5% vs. 0.7%, p=0.026). After multivariable adjustment, the relationship between PMI and short-term (≤ 30 day) cardiac mortality was significant (adjusted HR: 12.32, 95% CI: 1.07-141.37, p=0.044). However, PMI was not an independent prognostic factor of long-term cardiac mortality (adjusted HR: 2.59, 95% CI: 0.62-10.85, p=0.20).
PMI occurs in patients with a higher prevalence of adverse cardiac risks and predicts short-term but not long-term cardiac mortality in patients undergoing bifurcation lesion PCI.
经皮冠状动脉介入治疗（PCI）后，关于围手术期心肌梗死（PMI）的重要性仍存在争议。我们评估了 PCI 治疗分叉病变患者中 PMI 的预后意义。
2004 年 1 月至 2006 年 6 月，来自 16 个中心的接受非左主干分叉病变 PCI 的患者被纳入研究。PMI 定义为 PCI 后肌酸激酶同工酶-MB（CK-MB）峰值≥正常上限的 3 倍。我们比较了有和无 PMI 的患者之间的长期心脏死亡率。
在 1188 例患者中，有 119 例（10.0%）发生 PMI。左心室射血分数<50%（校正后的危险比[HR]：2.08，95%置信区间[CI]：1.13-3.82，p=0.018）、多支冠状动脉疾病（校正 HR：2.28，95% CI：1.36-3.81，p=0.002）和分支 PCI 相关的急性闭塞（校正 HR：3.34，95% CI：1.23-9.02，p=0.018）是 PMI 的显著危险因素。在中位随访 22.7 个月期间，有 PMI 的患者与无 PMI 的患者相比，未调整的长期心脏死亡率显著较高（2.5%比 0.7%，p=0.026）。在多变量调整后，PMI 与短期（≤30 天）心脏死亡率之间的关系具有统计学意义（校正 HR：12.32，95% CI：1.07-141.37，p=0.044）。然而，PMI 不是长期心脏死亡率的独立预后因素（校正 HR：2.59，95% CI：0.62-10.85，p=0.20）。
PMI 发生于具有更高不良心脏风险的患者中，预测 PCI 治疗分叉病变患者的短期但不是长期心脏死亡率。
