de Azevedo Diogo Freitas Cardoso, Hueb Whady, Lima Eduardo Gomes, Rezende Paulo Cury, Linhares Filho Jaime Paula Pessoa, de Carvalho Guilherme Fernandes, Martins Eduardo Bello, Nomura Cesar Higa, Strunz Celia Maria Cassaro, Serrano Junior Carlos Vicente, Ramires Jose Antonio Franchini, Kalil Filho Roberto
Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
Medicine (Baltimore). 2020 Feb;99(8):e18973. doi: 10.1097/MD.0000000000018973.
This study investigated the relationship between angiographic complexities of coronary artery disease (CAD) assessed by SYNTAX Score synergy between percutaneous coronary intervention with taxus and cardiac surgery score (SYNTAX Score) and cardiac biomarker elevation after revascularization procedures.This is a post-hoc analysis of the medicine, angioplasty or surgery study V study of patients with stable CAD. High-sensitivity troponin 1 (hs-TnI) and creatinine kinase-muscle/brain (CK-MB) were assessed before and after cardiovascular procedures. Baselines SYNTAX Scores (SXScores) were calculated by blinded investigators to patient characteristics.Of the 202 patients studied, the mean SXScore was 21.25 ± 9.24; 40.10 ± 7.09 in the high SXScore group and 19.06 ± 6.61 in low/mid SXscore group (P < .0001). Positive correlations existed between SXScore and median peaks after procedural hs-TnI (r = 0.18, P = .009) and CK-MB (r = 0.24, P = .001) levels. In patients with high SXScores (≥33), the median peaks of post-procedural hs-TnI (P = .034)and CK-MB (P = .004) levels were higher than in low/mid SXScore group (<33).The release of hs-TnI at 6 (P = .002), 12 (P = .008), and 24 hours (P = .039) was higher in high SXScore group than in low/mid SXscore group (<33) as was the release of CK-MB at 6 (P < .0001), 12 (P < .0001), 24 (P = .001), 36 (P = .007), 48 (P = .008), and 72 hours (P = .023). After multivariable analysis, high SXScore was a significant independent predictor of release of CK-MB and hs-TnI peaks higher than the median.The increase in release of cardiac biomarkers was significantly associated with the extent of atherosclerosis identified by the SYNTAX Score.
本研究调查了通过SYNTAX评分(经皮冠状动脉介入治疗与心脏手术评分系统评分)评估的冠状动脉疾病(CAD)血管造影复杂性与血运重建术后心脏生物标志物升高之间的关系。这是对稳定性CAD患者的药物、血管成形术或手术研究V研究的事后分析。在心血管手术前后评估高敏肌钙蛋白I(hs-TnI)和肌酸激酶同工酶(CK-MB)。由对患者特征不知情的研究人员计算基线SYNTAX评分(SXScores)。在202例研究患者中,平均SXScores为21.25±9.24;高SXScores组为40.10±7.09,低/中SXScores组为19.06±6.61(P<0.0001)。SXScores与术后hs-TnI(r = 0.18,P = 0.009)和CK-MB(r = 0.24,P = 0.001)水平的中位数峰值之间存在正相关。在高SXScores(≥33)的患者中,术后hs-TnI(P = 0.034)和CK-MB(P = 0.004)水平的中位数峰值高于低/中SXScores组(<33)。高SXScores组在6小时(P = 0.002)、12小时(P = 0.008)和24小时(P = 0.039)时hs-TnI的释放高于低/中SXScores组(<33),CK-MB在6小时(P<0.0001)、12小时(P<0.0001)、24小时(P = 0.001)、36小时(P = 0.007)、48小时(P = 0.008)和72小时(P = 0.023)时的释放情况也是如此。多变量分析后,高SXScores是CK-MB和hs-TnI峰值释放高于中位数的显著独立预测因素。心脏生物标志物释放的增加与SYNTAX评分所确定的动脉粥样硬化程度显著相关。