Department of Clinical Cardiology, Heart Institute (InCor) University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Room 114, Cerqueira César, São Paulo 05403-000, Brazil.
Eur Heart J Cardiovasc Imaging. 2022 Jan 24;23(2):255-265. doi: 10.1093/ehjci/jeaa328.
Cardiac biomarkers elevation is common after revascularization, even in absence of periprocedural myocardial infarction (PMI) detection by imaging methods. Thus, late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) may be useful on PMI diagnosis and prognosis. We sought to evaluate long-term prognostic value of PMI and new LGE after revascularization.
Two hundred and two patients with multivessel coronary disease and preserved ventricular function who underwent elective revascularization were included, of whom 136 (67.3%) underwent coronary artery bypass grafting and 66 (32.7%) percutaneous coronary intervention. The median follow-up was 5 years (4.8-5.8 years). Cardiac biomarkers measurement and LGE-CMR were performed before and after procedures. The Society for Cardiovascular Angiography and Interventions definition was used to assess PMI. Primary endpoint was composed of death, infarction, additional revascularization, or cardiac hospitalization. Primary endpoint was observed in 29 (14.3%) patients, of whom 13 (14.9%) had PMI and 16 (13.9%) did not (P = 0.93). Thirty-six (17.8%) patients had new LGE. Twenty (12.0%) events occurred in patients without new LGE and 9 (25.2%) in patients with it (P = 0.045). LGE was also associated to increased mortality, with 4 (2.4%) and 4 (11.1%) deaths in subjects without and with it (P = 0.02). LGE was the only independent predictor of primary endpoint and mortality (P = 0.03 and P = 0.02). Median LGE mass was estimated at 4.6 g. Patients with new LGE had a greater biomarkers release (median troponin: 8.9 ng/mL vs. 1.8 ng/mL and median creatine kinase-MB: 38.0 ng/mL vs. 12.3 ng/mL; P < 0.001 in both comparisons).
New LGE was shown to be better prognostic predictor than biomarker-only PMI definition after uncomplicated revascularization. Furthermore, new LGE was the only independent predictor of cardiovascular events and mortality.
即使通过影像学方法未检测到围手术期心肌梗死（PMI），血运重建后也常出现心脏生物标志物升高。因此，晚期钆增强心脏磁共振（LGE-CMR）可能有助于 PMI 的诊断和预后。我们旨在评估 PMI 和血运重建后新出现的 LGE 的长期预后价值。
共纳入 202 例患有多支血管性冠状动脉疾病且心室功能正常的患者，他们接受了择期血运重建，其中 136 例（67.3%）接受了冠状动脉旁路移植术，66 例（32.7%）接受了经皮冠状动脉介入治疗。中位随访时间为 5 年（4.8-5.8 年）。在手术前后进行心脏生物标志物测量和 LGE-CMR。采用心血管造影与介入学会（SCAI）的定义来评估 PMI。主要终点由死亡、梗死、再次血运重建或心脏住院组成。29 例（14.3%）患者发生了主要终点事件，其中 13 例（14.9%）发生了 PMI，16 例（13.9%）未发生（P=0.93）。36 例（17.8%）患者出现了新的 LGE。无新 LGE 的患者中有 20 例（12.0%）发生事件，而有新 LGE 的患者中有 9 例（25.2%）发生事件（P=0.045）。LGE 也与死亡率增加相关，无新 LGE 的患者中有 4 例（2.4%）和有新 LGE 的患者中有 4 例（11.1%）死亡（P=0.02）。LGE 是主要终点和死亡率的唯一独立预测因素（P=0.03 和 P=0.02）。中位数 LGE 质量估计为 4.6g。有新 LGE 的患者释放出更多的生物标志物（中位数肌钙蛋白：8.9ng/mL 比 1.8ng/mL 和中位数肌酸激酶-MB：38.0ng/mL 比 12.3ng/mL；在这两种比较中均 P<0.001）。
在未发生并发症的血运重建后，新的 LGE 比仅基于生物标志物的 PMI 定义更能预测预后。此外，新的 LGE 是心血管事件和死亡率的唯一独立预测因素。
