Institute of Cardiology, Università Cattolica Del Sacro Cuore, Rome, Italy.
Catheter Cardiovasc Interv. 2014 Jan 1;83(1):E37-44. doi: 10.1002/ccd.25102. Epub 2013 Aug 5.
To assess the predictive value of C-reactive protein (CRP) on periprocedural myocardial injury (PMI), evaluated by creatine kinase-myocardial band isoform (CK-MB) elevation in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for the treatment of coronary bifurcation lesions is actually unknown.
Systemic inflammation as assessed by CRP has been associated with averse events after DES implantation. After PCI, the occurrence of PMI is common and has also been associated with worse outcomes. Finally, bifurcations are frequently encountered anatomically complex lesions which the treatment is associated with higher complication rate compared with simple lesions.
A total of 96 patients (66 ± 10 years, 70 men) from the Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents (CACTUS) trial who had baseline CRP dosage and both baseline and postprocedural CK-MB measurement were included.
A complex bifurcation strategy was implemented in 53 (55%) patients, and angiographic success was achieved in all but two (2%) patients. Periprocedural myocardial necrosis (increase of CK-MB between one and three times the upper limit of normal [ULN]) was observed in 12 (13%) patients, and four (4%) patients had PCI-related myocardial infarction (increase of CK-MB more than three times ULN). Notably, progressively higher CRP levels were observed in patients with different increase in CK-MB (P = 0.041). Moreover, CRP >1 mg/L significantly predicted CK-MB rise (odds ratio 5.6, 95% confidence interval 1.5-4.3, P = 0.011).
In the setting of true coronary bifurcations treated by DES, baseline CRP levels were significantly associated with both the incidence and the extent of PMI.
评估 C 反应蛋白（CRP）对经皮冠状动脉介入治疗（PCI）中药物洗脱支架（DES）植入治疗冠状动脉分叉病变患者围术期心肌损伤（PMI）的预测价值，CK-MB 升高可评估 PMI。背景：CRP 评估的全身炎症与 DES 植入后不良事件相关。PCI 后，PMI 的发生较为常见，且与预后不良相关。最后，分叉是解剖结构复杂的常见病变，其治疗与简单病变相比，并发症发生率更高。方法：共纳入来自 Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents（CACTUS）试验的 96 例患者（66±10 岁，70 例男性），这些患者基线 CRP 检测值和基线及术后 CK-MB 检测值均可用。结果：53 例（55%）患者采用复杂分叉策略，除 2 例（2%）外，所有患者均实现了血管造影成功。12 例（13%）患者发生围术期心肌坏死（CK-MB 升高 13 倍正常值上限[ULN]），4 例（4%）患者发生 PCI 相关心肌梗死（CK-MB 升高超过 3 倍 ULN）。值得注意的是，CK-MB 升高不同的患者 CRP 水平逐渐升高（P=0.041）。此外，CRP>1mg/L 显著预测 CK-MB 升高（比值比 5.6，95%置信区间 1.54.3，P=0.011）。结论：在真正的冠状动脉分叉病变患者中，DES 治疗后，基线 CRP 水平与 PMI 的发生率和程度显著相关。
