Idris Hanan, Lo Sidney, Shugman Ibrahim M, Saad Yousef, Hopkins Andrew P, Mussap Christian, Leung Dominic, Thomas Liza, Juergens Craig P, French John K
Cardiology Department, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia (H.I., S.L., I.M.S., Y.S., A.P.H., C.M., D.L., L.T., C.P.J., J.K.F.).
J Am Heart Assoc. 2014 Oct 30;3(6):e001086. doi: 10.1161/JAHA.114.001086.
Periprocedural myocardial infarction (PMI) has had several definitions in the last decade, including the Society for Cardiovascular Angiography and Interventions (SCAI) definition, that requires marked biomarker elevations congruent with surgical PMI criteria.
The aim of this study was to examine the definition-based frequencies of PMI and whether they influenced the reported association between PMI and increased rates of late death/ myocardial infarction (MI). We studied 742 patients; 492 (66%) had normal troponin T (TnT) levels and 250 (34%) had elevated, but stable or falling, TnT levels. PMI, using the 2007 and the 2012 universal definition, occurred in 172 (23.2%) and in 99 (13.3%) patients, respectively, whereas 19 (2.6%) met the SCAI PMI definition (P<0.0001). Among patients with PMI using the 2012 definition, occlusion of a side branch ≤1 mm occurred in 48 patients (48.5%) and was the most common angiographic finding for PMI. The rates of death/MI at 2 years in patients with, compared to those without, PMI was 14.7% versus 10.1% (P=0.087) based on the 2007 definition, 16.9% versus 10.3% (P=0.059) based on the 2012 definition, and 29.4% versus 10.7% (P=0.015) based on the SCAI definition.
In this study, PMI, according to the SCAI definition, was associated with more-frequent late death/MI, with ≈20% of all patients, who had PMI using the 2007 universal MI definition, not having SCAI-defined PMI. Categorizing these latter patients as SCAI-defined no PMI did not alter the rate of death/MI among no-PMI patients.
在过去十年中，围手术期心肌梗死（PMI）有多种定义，包括心血管造影和介入学会（SCAI）的定义，该定义要求生物标志物显著升高，符合手术PMI标准。
本研究的目的是检查基于定义的PMI发生率，以及它们是否影响所报告的PMI与晚期死亡/心肌梗死（MI）发生率增加之间的关联。我们研究了742例患者；492例（66%）肌钙蛋白T（TnT）水平正常，250例（34%）TnT水平升高，但稳定或下降。根据2007年和2012年通用定义，PMI分别发生在172例（23.2%）和99例（13.3%）患者中，而19例（2.6%）符合SCAI PMI定义（P<0.0001）。在根据2012年定义患有PMI的患者中，48例（48.5%）出现侧支血管闭塞≤1mm，这是PMI最常见的血管造影表现。根据2007年定义，有PMI的患者与无PMI的患者相比，2年时死亡/MI发生率分别为14.7%和10.1%（P=0.087）；根据2012年定义，分别为16.9%和10.3%（P=0.059）；根据SCAI定义，分别为29.4%和10.7%（P=0.015）。
在本研究中，根据SCAI定义，PMI与更频繁的晚期死亡/MI相关联，在所有根据2007年通用MI定义患有PMI的患者中，约20%不符合SCAI定义的PMI。将这些患者归类为SCAI定义的无PMI患者，并未改变无PMI患者的死亡/MI发生率。
