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接受经皮冠状动脉介入治疗患者的维生素D缺乏与围手术期心肌梗死

Vitamin D deficiency and periprocedural myocardial infarction in patients undergoing percutaneous coronary interventions.

作者信息

Verdoia Monica, Ceccon Claudia, Nardin Matteo, Suryapranata Harry, De Luca Giuseppe

机构信息

Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.

Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy; Department of Internal Medicine, Spedali Civili, Brescia, Italy.

出版信息

Cardiovasc Revasc Med. 2018 Oct;19(7 Pt A):744-750. doi: 10.1016/j.carrev.2018.03.002. Epub 2018 Mar 4.

Abstract

Vitamin D deficiency has been implicated in the progression of atherosclerosis and acute thrombotic events. We aimed at evaluating the impact of vitamin D deficiency on periprocedural myocardial infarction (PMI) in patients undergoing percutaneous coronary interventions (PCI). We included 934 patients undergoing non-urgent PCI. Assessment of myocardial biomarkers was performed from 6 to 48 h after PCI. PMI was defined as Creatine Kinase-MB increase by 3 times the Upper Limit Normal or by 50% of an elevated baseline value, periprocedural myocardial damage as Troponin I increase by 3 × ULN or 50% of baseline. Patients were divided according to vitamin D tertiles values (<10.2 ng/ml; 10.2-18.7 ng/ml; ≥18.8 ng/ml). Lower tertiles values of vitamin D were associated with age (p = 0.04), female gender, (p = 0.001), and a higher cardiovascular risk profile. Lower vitamin D levels related with PCI of descending anterior coronary artery or bypass vein grafts (p = 0.03), treatment of bifurcations (p = 0.05) and side branch loss (p = 0.05) and inversely with direct stenting (p = 0.002). However, lower vitamin D levels did not influence the risk of PMI (adjusted OR [95% CI] = 0.81[0.65,1.18], p = 0.09) or periprocedural myocardial damage (adjusted OR [95% CI] = 0.93[0.77,1.13], p = 0.48). Similar results were achieved when considering the severity of vitamin D deficiency. Therefore, in patients undergoing PCI, no association was observed between vitamin D deficiency and the risk of periprocedural MI and myocardial damage.

摘要

维生素D缺乏与动脉粥样硬化进展及急性血栓形成事件有关。我们旨在评估维生素D缺乏对接受经皮冠状动脉介入治疗(PCI)患者围手术期心肌梗死(PMI)的影响。我们纳入了934例接受非紧急PCI的患者。PCI术后6至48小时进行心肌生物标志物评估。PMI定义为肌酸激酶同工酶(CK-MB)升高至正常上限的3倍或基线升高值的50%,围手术期心肌损伤定义为肌钙蛋白I升高至3×正常上限(ULN)或基线的50%。患者根据维生素D三分位数水平进行分组(<10.2 ng/ml;10.2 - 18.7 ng/ml;≥18.8 ng/ml)。较低的维生素D三分位数水平与年龄(p = 0.04)、女性(p = 0.001)及更高的心血管风险特征相关。较低的维生素D水平与前降支冠状动脉或旁路静脉移植血管的PCI(p = 0.03)、分叉病变治疗(p = 0.05)及边支丢失(p = 0.05)相关,与直接支架置入术呈负相关(p = 0.002)。然而,较低的维生素D水平并未影响PMI风险(校正后比值比[95%置信区间]=0.81[0.65,1.18],p = 0.09)或围手术期心肌损伤(校正后比值比[95%置信区间]=0.93[0.77,1.13],p = 0.48)。考虑维生素D缺乏的严重程度时也得到了类似结果。因此,在接受PCI的患者中,未观察到维生素D缺乏与围手术期心肌梗死风险及心肌损伤之间存在关联。

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