Putot Alain, Chagué Frédéric, Manckoundia Patrick, Brunel Philippe, Beer Jean-Claude, Cottin Yves, Zeller Marianne
Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France.
Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France.
J Clin Med. 2020 May 26;9(6):1608. doi: 10.3390/jcm9061608.
Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. In this prospective multicenter study from coronary care units, we performed propensity score-matched analysis to compare outcomes in patients with and without PCI for post-infectious MI with angiography-proven significant coronary stenosis (>50%). Among 4573 consecutive MI patients, 476 patients (10%) had a concurrent diagnosis of acute infection at admission, of whom 375 underwent coronary angiography and 321 patients had significant stenosis. Among the 321 patients, 195 underwent PCI. Before the matching procedure, patients without PCI had a similar age and sex ratio but a higher rate of risk factors (hypertension, diabetes, chronic renal failure, and prior coronary artery disease), pneumonia, and SYNTAX score than patients without PCI. After propensity score matching, neither in-hospital mortality (13% with PCI vs. 8% without PCI; = 0.4) nor one-year mortality (24% with PCI vs. 19% without PCI, = 0.5) significantly differed between the two groups. In this first prospective cohort of post-infectious MI in coronary care units, PCI might not improve short- and long-term prognosis in patients with angiography-proven significant coronary stenosis. If confirmed, these results do not argue for systematic invasive procedures after post-infectious MI.
急性感染是心肌梗死（MI）的常见诱因。然而，经皮冠状动脉介入治疗（PCI）能否改善感染后心肌梗死的预后是一个重大但尚未解决的问题。在这项来自冠心病监护病房的前瞻性多中心研究中，我们进行了倾向评分匹配分析，以比较经血管造影证实存在显著冠状动脉狭窄（>50%）的感染后心肌梗死患者接受PCI与未接受PCI的预后情况。在4573例连续的心肌梗死患者中，476例（10%）在入院时同时诊断为急性感染，其中375例接受了冠状动脉造影，321例患者存在显著狭窄。在这321例患者中，195例接受了PCI。在匹配程序之前，未接受PCI的患者年龄和性别比例相似，但危险因素（高血压、糖尿病、慢性肾功能衰竭和既往冠状动脉疾病）、肺炎和SYNTAX评分的发生率高于接受PCI的患者。倾向评分匹配后，两组的院内死亡率（接受PCI的患者为13%，未接受PCI的患者为8%；P = 0.4）和一年死亡率（接受PCI的患者为24%，未接受PCI的患者为19%，P = 0.5）均无显著差异。在冠心病监护病房的这首个感染后心肌梗死前瞻性队列中，对于经血管造影证实存在显著冠状动脉狭窄的患者，PCI可能无法改善其短期和长期预后。如果得到证实，这些结果并不支持在感染后心肌梗死后进行系统性侵入性操作。
