Shibata Yohei, Ishii Hideki, Suzuki Susumu, Tanaka Akihito, Tatami Yosuke, Harata Shingo, Ota Tomoyuki, Shimbo Yusaku, Takayama Yohei, Kunimura Ayako, Hirayama Kenshi, Harada Kazuhiro, Osugi Naohiro, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine.
J Atheroscler Thromb. 2017 May 1;24(5):487-494. doi: 10.5551/jat.36582. Epub 2016 Oct 13.
Previous studies have shown that aortic valve calcification (AVC) was associated with cardiovascular events and mortality. On the other hand, periprocedural myocardial injury (PMI) in percutaneous coronary intervention (PCI) is a well-known predictor of subsequent mortality and poor clinical outcomes. The purpose of the study was to assess the hypothesis that the presence of AVC could predict PMI in PCI.
This study included 370 patients treated with PCI for stable angina pectoris. AVC was defined as bright echoes ＞1 mm on one or more cusps of the aortic valve on ultrasound cardiography (UCG). PMI was defined as an increase in high-sensitivity troponin T level of ＞5 times the upper normal limit (＞0.070 ng/ml) at 24 hours after PCI.
AVC was detected in 45.9% of the patients (n=170). The incidence of PMI was significantly higher in the patients with AVC than in those without AVC (43.5% vs 21.0%, p＜0.001). The presence of AVC independently predicted PMI after adjusting for other significant variables (odds ratio 2.26, 95% confidence interval 1.37-3.74, p=0.002). Other predictors were male sex, age, estimated glomerular filtration rate, and total stent length. Furthermore to predict PMI, adding AVC to the established risk factors significantly improved the area under the receiver operating characteristic curves, from 0.68 to 0.72, of the PMI prediction model (p=0.025).
The presence of AVC detected in UCG could predict the incidence of PMI.
既往研究表明，主动脉瓣钙化（AVC）与心血管事件及死亡率相关。另一方面，经皮冠状动脉介入治疗（PCI）中的围手术期心肌损伤（PMI）是后续死亡率及不良临床结局的一个众所周知的预测指标。本研究的目的是评估AVC的存在能否预测PCI中的PMI这一假设。
本研究纳入了370例因稳定型心绞痛接受PCI治疗的患者。AVC定义为超声心动图（UCG）显示主动脉瓣一个或多个瓣叶上有＞1mm的明亮回声。PMI定义为PCI术后24小时高敏肌钙蛋白T水平升高至正常上限的5倍以上（＞0.070ng/ml）。
45.9%的患者（n=170）检测到AVC。有AVC的患者中PMI的发生率显著高于无AVC的患者（43.5%对21.0%，p＜0.001）。在对其他显著变量进行校正后，AVC的存在独立预测PMI（比值比2.26，95%置信区间1.37 - 3.74，p=0.002）。其他预测因素为男性、年龄、估计肾小球滤过率和总支架长度。此外，为了预测PMI，在已有的危险因素中加入AVC显著改善了PMI预测模型的受试者工作特征曲线下面积，从0.68提高到0.72（p=0.025）。
UCG检测到的AVC的存在可预测PMI的发生率。
