经腔内血运重建治疗严重肢体缺血后心肌损伤预测 1 年死亡率：一项前瞻性观察队列研究。
Myocardial injury after endovascular revascularization in critical limb ischemia predicts 1-year mortality: a prospective observational cohort study.
机构信息
Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
Department of Medicine, Jagiellonian University Medical College, ul. Skawińska 8, 31-066, Krakow, Poland.
出版信息
Clin Res Cardiol. 2018 Apr;107(4):319-328. doi: 10.1007/s00392-017-1185-z. Epub 2017 Nov 24.
BACKGROUND
Patients with critical limb ischemia (CLI) are at increased risk of cardiovascular complications and mortality. To determine (1) incidence of myocardial injury following endovascular revascularization, and (2) relationship between myocardial injury with 1-year mortality and major adverse cardiovascular events (MACE; i.e., composite of myocardial infarction, stroke, and death).
METHODS AND RESULTS
Single-center, prospective cohort study of CLI patients ≥ 45 years of age, who underwent endovascular revascularization with overnight hospitalization. High-sensitive troponins T (hsTnTs) were measured on admission, 3-6 h after endovascular revascularization and the subsequent morning. Myocardial injury after endovascular revascularization was defined as an hsTnT ≥ 14 ng/L with a relative increase ≥ 30% from the baseline value. We also evaluated other myocardial injury hsTnT thresholds (i.e., ≥ 30, ≥ 40, ≥ 60, and ≥ 80 ng/L). 239 consecutive patients (56% male, mean age 71.5 ± 10.1 years) were included; one patient was lost to follow-up. At 1 year, there were 34 deaths (14.2%), and 48 MACE (20.5%). Myocardial injury with the hsTnT threshold of 14 ng/L and relative increase by ≥ 30% from the baseline level occurred in 61 patients (25.5%). Myocardial injury was independently associated with 1-year mortality ([aHR], 2.44; 95% CI 1.18-5.06, for hsTnT ≥ 14 ng/L to aHR, 3.34; 95% CI 1.29-8.65 for hsTnT ≥ 80 ng/L). Myocardial injury was also independently associated with 1-year MACE ([AOR] 2.89; 95% CI 1.41-5.92 for hsTnT ≥ 14 ng/L to AOR, 6.69; 95% CI 2.17-20.68 for hsTnT ≥ 80 ng/L). 85.2% patients who had myocardial injury did not have ischemic clinical symptoms or electrocardiography changes. In sensitive analysis with exclusion of symptomatic patients that developed myocardial injury for the hsTnT ≥ 14 ng/L threshold, both the 1-year mortality (aHR: 2.19; CI 1.02-4.68; p = 0.04), and 1-year MACE (OR 2.25; CI 1.06-4.77; p = 0.036) remained significant.
CONCLUSIONS
Myocardial injury is common following endovascular revascularization for CLI and associated with the risk of 1-year mortality and MACE.
背景
患有严重肢体缺血（CLI）的患者心血管并发症和死亡率的风险增加。目的：（1）确定血管内血运重建后心肌损伤的发生率；（2）评估心肌损伤与 1 年死亡率和主要不良心血管事件（MACE；即心肌梗死、卒中和死亡的组合）之间的关系。
方法和结果
这是一项单中心前瞻性队列研究，纳入年龄≥45 岁的 CLI 患者，他们接受血管内血运重建并住院过夜。在入院时、血管内血运重建后 3-6 小时和随后的早晨测量高敏肌钙蛋白 T（hsTnTs）。血管内血运重建后心肌损伤定义为 hsTnT≥14ng/L，与基线值相比相对增加≥30%。我们还评估了其他心肌损伤 hsTnT 阈值（即≥30、≥40、≥60 和≥80ng/L）。纳入了 239 例连续患者（56%为男性，平均年龄 71.5±10.1 岁）；1 例患者失访。1 年后，有 34 例死亡（14.2%）和 48 例 MACE（20.5%）。hsTnT 阈值为 14ng/L 且与基线值相比相对增加≥30%的患者有 61 例（25.5%）发生心肌损伤。心肌损伤与 1 年死亡率独立相关（[aHR]，2.44；95%CI，1.18-5.06，hsTnT≥14ng/L 的 aHR，3.34；95%CI，1.29-8.65，hsTnT≥80ng/L）。心肌损伤也与 1 年 MACE 独立相关（[AOR]，2.89；95%CI，1.41-5.92，hsTnT≥14ng/L 的 AOR，6.69；95%CI，2.17-20.68，hsTnT≥80ng/L）。有心肌损伤的 85.2%患者没有缺血性临床症状或心电图变化。在对 hsTnT≥14ng/L 阈值的有症状患者发生心肌损伤进行排除的敏感分析中，1 年死亡率（aHR：2.19；CI 1.02-4.68；p=0.04）和 1 年 MACE（OR 2.25；CI 1.06-4.77；p=0.036）仍有显著意义。
结论
CLI 血管内血运重建后心肌损伤很常见，与 1 年死亡率和 MACE 风险相关。
Zotero 插件