Gili Sebastiano, D'Ascenzo Fabrizio, Moretti Claudio, Omedè Pierluigi, Vilardi Ilaria, Bertaina Maurizio, Biondi Zoccai Giuseppe, Sheiban Imad, Stone Gregg W, Gaita Fiorenzo
Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy.
J Interv Cardiol. 2014 Oct;27(5):482-90. doi: 10.1111/joic.12143. Epub 2014 Aug 30.
Different definitions of periprocedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) have been provided, but their impact on prognosis remains to be determined.
Procedural data from consecutive patients undergoing PCI from 2009 to 2011 were revised to adjudicate diagnosis of periprocedural MI according to CK-MB increase (>3 × URL and >5 × URL), to troponin increase (>3 × 99th percentile URL and >5 × 99th percentile URL) and to recent 2012 Task Force and Society for Cardiovascular Angiography and Interventions (SCAI) definitions. Major adverse cardiovascular events (MACE) was the primary end-point.
Seven hundred twelve patients were enrolled; after 771 days, 115 (16.7%) patients experienced MACE. One hundred ninety patients were diagnosed with a periprocedural MI defined as elevation of troponin >5 × 99th percentile of URL. When adjudicating 2012 Task Force definition on these patients, 46 were excluded and 1.4% of them experienced a MACE and 0.3% died, while among 144 with periprocedural MI, 2.9% reported a MACE and 1.3% died. After appraisal of SCAI definition, 176 patients were excluded, 3.8% of them with a MACE and 1.4% died, and for those with periprocedural MI, 0.5% experienced a MACE and 0.1% died. Similar low performance was appraised after reclassification of patients from more than 3 of upper limit of CK-MB and of troponin. At multivariate analysis, none of these definitions related to adverse events.
Periprocedural MI represents a frequent complication for patients undergoing PCI. All present definitions share a still not satisfactory discrimination between patients with and without adverse events at follow-up, stressing the need for more accurate definitions.
经皮冠状动脉介入治疗（PCI）后围手术期心肌梗死（MI）的定义各异，但其对预后的影响仍有待确定。
回顾2009年至2011年连续接受PCI治疗患者的手术数据，根据肌酸激酶同工酶（CK-MB）升高（>3×正常上限值（URL）且>5×URL）、肌钙蛋白升高（>3×第99百分位数URL且>5×第99百分位数URL）以及2012年工作组和心血管造影与介入学会（SCAI）的最新定义来判定围手术期MI的诊断。主要不良心血管事件（MACE）为主要终点。
共纳入712例患者；771天后，115例（16.7%）患者发生MACE。190例患者被诊断为围手术期MI，定义为肌钙蛋白升高>5×第99百分位数URL。按照2012年工作组定义对这些患者进行判定时，46例被排除，其中1.4%发生MACE，0.3%死亡；而在144例围手术期MI患者中，2.9%发生MACE，1.3%死亡。根据SCAI定义评估后，176例患者被排除，其中3.8%发生MACE，1.4%死亡；对于围手术期MI患者，0.5%发生MACE，0.1%死亡。对CK-MB和肌钙蛋白超过正常上限值3倍以上的患者重新分类后，评估结果类似，表现不佳。多因素分析显示，这些定义均与不良事件无关。
围手术期MI是接受PCI治疗患者的常见并发症。目前所有定义在区分随访中有不良事件和无不良事件患者方面仍不尽人意，强调需要更准确的定义。
