Watanabe Hirotoshi, Morimoto Takeshi, Shiomi Hiroki, Yoshikawa Yusuke, Kato Takao, Saito Naritatsu, Shizuta Satoshi, Ono Koh, Yamaji Kyohei, Ando Kenji, Kaji Shuichiro, Furukawa Yutaka, Akao Masaharu, Ishikawa Tetsuya, Tamura Takashi, Yamamoto Yoshito, Muramatsu Toshiya, Suwa Satoru, Nakagawa Yoshihisa, Kadota Kazushige, Takatsu Yoshiki, Nishikawa Hideo, Hiasa Yoshikazu, Hayashi Yasuhiko, Miyazaki Shunichi, Kimura Takeshi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
Cardiovasc Interv Ther. 2019 Jan;34(1):47-58. doi: 10.1007/s12928-018-0517-x. Epub 2018 Mar 5.
It is unknown whether there is a threshold of creatine kinase (CK) or CK-MB affecting the subsequent mortality for post-discharge myocardial infarction (PDMI) after percutaneous coronary intervention. Current study sought to evaluate the impact of PDMI. The study population included 30,051 patients with successful coronary stenting and discharged alive in the pooled patient-level database of 4 Japanese studies (j-Cypher registry, CREDO-Kyoto PCI/CABG registry cohort-2, RESET, and NEXT). During 4.4 ± 1.4 year follow-up, 915 patients experienced PDMI (cumulative 5-year incidence of 3.6%). Among 466 patients with available peak CK ratio (peak CK/upper limit of normal), peak CK ratio (< 3) was present in 21% of patients, while peak CK ratios (≥ 3 and < 5), (≥ 5 and < 10), (≥ 10 and < 30), and (≥ 30) were present in 17, 25, 30, and 7.3% of patients, respectively. The excess mortality risk of patients with relative to those without PDMI for subsequent mortality was significant (adjusted HR 5.12, 95% CI 4.52-5.80, P < 0.001) by the Cox model with PDMI incorporated as the time-updated covariate. However, the mortality risk of patients in the smallest peak CK ratio category (< 3) was insignificant (HR 0.85, 95% CI 0.43-1.71, P = 0.65). In conclusion, despite significant overall mortality risk of PDMI, the mortality risk of small PDMI was similar to that of no PDMI, suggesting the presence of some threshold about infarct size influencing mortality.Trial registrations The Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial (RESET); NCT01035450 and NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial (NEXT); NCT01303640. J-Cypher and CREDO-Kyoto PCI/CABG registry cohort 2 were not registered into clinical trial database.
经皮冠状动脉介入治疗后出院后心肌梗死（PDMI）时，肌酸激酶（CK）或肌酸激酶同工酶（CK-MB）是否存在影响后续死亡率的阈值尚不清楚。本研究旨在评估PDMI的影响。研究人群包括来自4项日本研究（j-Cypher注册研究、CREDO-Kyoto PCI/CABG注册队列-2、RESET和NEXT）汇总的患者水平数据库中30051例成功进行冠状动脉支架置入并存活出院的患者。在4.4±1.4年的随访期间，915例患者发生了PDMI（5年累积发病率为3.6%）。在466例可获得峰值CK比值（峰值CK/正常上限）的患者中，21%的患者峰值CK比值<3，而峰值CK比值≥3且<5、≥5且<10、≥10且<30和≥30的患者分别占17%、25%、30%和7.3%。将PDMI作为时间更新协变量纳入Cox模型后，发生PDMI的患者相对于未发生PDMI的患者后续死亡的额外死亡风险显著（调整后HR 5.12，95%CI 4.52-5.80，P<0.001）。然而，峰值CK比值最小类别（<3）的患者死亡风险不显著（HR 0.85，95%CI 0.43-1.71，P=0.65）。总之，尽管PDMI总体死亡风险显著，但小面积PDMI的死亡风险与无PDMI者相似，提示存在影响死亡率的梗死面积阈值。试验注册：西罗莫司洗脱支架与依维莫司洗脱支架随机评估试验（RESET）；NCT01035450和 Nobori生物可降解涂层依维莫司洗脱支架与XIENCE/PROMUS依维莫司洗脱支架试验（NEXT）；NCT01303640。J-Cypher和CREDO-Kyoto PCI/CABG注册队列2未注册到临床试验数据库中。
