Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea.
Eur Heart J. 2013 Jun;34(22):1662-9. doi: 10.1093/eurheartj/eht048. Epub 2013 Feb 12.
Peri-procedural myocardial infarction (MI) is a not infrequent complication of percutaneous coronary intervention (PCI), but conflicting information exists regarding incidence and prognostic impact of this event. We investigated frequency, causes, predictors, and clinical relevance of peri-procedural MI, using a large database.
We pooled individual patient-level data from 11 PCI studies in which peri-procedural creatine kinase-MB mass was routinely measured and mortality data were prospectively collected. Among 23 604 patients from 11 studies, 1677 {7.1% [95% confidence interval (CI) 6.8-7.5%]} had peri-procedural MI. The most common mechanism of peri-procedural MI was side-branch occlusion. Independent predictors of peri-procedural MI were older age, female gender, diabetes, hypertension, renal dysfunction, multivessel disease, left anterior descending artery disease, left main disease, bifurcation lesion, long lesion, drug-eluting stents, and number of stents. Follow-up varied from 1 year to 5 years. In a crude analysis, patients with peri-procedural MI had significantly a higher risk of mortality than those without peri-procedural MI [hazard ratio (HR) 1.47; 95% CI 1.24-1.74]. After adjustment for baseline covariates, peri-procedural MI was associated with an increased risk of mortality (HR 1.20; 95% CI 1.04-1.39).
Among patients undergoing PCI, the occurrence of peri-procedural MI measured by CK-MB mass assay was ~7%, and more than half of cases were associated with side-branch occlusion. Several higher risk patients, lesions, and procedural characteristics were independent predictors of peri-procedural MI. Peri-procedural MI was associated with an increase in mortality.
经皮冠状动脉介入治疗（PCI）围手术期心肌梗死（MI）并不少见，但该事件的发生率和预后影响存在相互矛盾的信息。我们使用大型数据库研究了围手术期 MI 的频率、原因、预测因素和临床相关性。
我们汇总了 11 项 PCI 研究的个体患者水平数据，这些研究中常规测量了围手术期肌酸激酶同工酶-MB 质量，前瞻性地收集了死亡率数据。在来自 11 项研究的 23604 例患者中，1677 例（7.1%[95%置信区间（CI）6.8-7.5%]）发生了围手术期 MI。围手术期 MI 最常见的机制是侧支闭塞。围手术期 MI 的独立预测因素包括年龄较大、女性、糖尿病、高血压、肾功能不全、多血管疾病、前降支病变、左主干病变、分叉病变、长病变、药物洗脱支架和支架数量。随访时间从 1 年到 5 年不等。在粗分析中，与无围手术期 MI 的患者相比，发生围手术期 MI 的患者死亡风险显著更高[风险比（HR）1.47；95%CI 1.24-1.74]。在调整基线协变量后，围手术期 MI 与死亡风险增加相关（HR 1.20；95%CI 1.04-1.39）。
在接受 PCI 的患者中，通过 CK-MB 质量测定测量的围手术期 MI 的发生率约为 7%，超过一半的病例与侧支闭塞有关。一些高危患者、病变和手术特征是围手术期 MI 的独立预测因素。围手术期 MI 与死亡率增加相关。
