Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Cardiol. 2021 Jun 15;333:60-68. doi: 10.1016/j.ijcard.2021.03.018. Epub 2021 Mar 18.
Debate exists on the prognostic significance of spontaneous myocardial infarction (SMI) and periprocedural myocardial infarction (PMI), which could be diagnosed by various definitions.
A total of 10,724 patients undergoing percutaneous coronary intervention (PCI) were consecutively enrolled and followed up for a median of 2.4 years. We evaluated outcomes of all-cause death, cardiac death, and major adverse cardiovascular events (MACE). Patients were stratified into three groups, including the No MI group, PMI group, and SMI group. PMI was defined based on different diagnostic criteria, including the third and fourth universal myocardial infarction (MI) definitions, the society for cardiovascular angiography and interventions (SCAI) definition, and the independent biomarker definition. Regardless of these definitions, the PMI groups were all associated with a significantly increased MACE risk at one year or 1000 days (all P < 0.05), but not all-cause or cardiac death. The SMI group was associated with a markedly elevated risk of death and MACE, but it showed no significant different risk of MACE to PMI using varying definitions.
According to various PMI definitions, PMI and SMI were associated with an increased risk of MACE, but not death for PMI. No significantly different risk of MACE was observed between PMI and SMI.
自发性心肌梗死（SMI）和围手术期心肌梗死（PMI）的预后意义存在争议，可以通过各种定义进行诊断。
连续纳入了 10724 例行经皮冠状动脉介入治疗（PCI）的患者，并随访了中位数为 2.4 年的时间。我们评估了全因死亡、心脏性死亡和主要不良心血管事件（MACE）的结局。患者分为三组，包括无 MI 组、PMI 组和 SMI 组。PMI 是根据不同的诊断标准定义的，包括第三次和第四次通用心肌梗死（MI）定义、心血管造影和介入学会（SCAI）定义以及独立生物标志物定义。无论采用何种定义，PMI 组在一年或 1000 天内均与显著增加的 MACE 风险相关（均 P < 0.05），但与全因或心脏性死亡无关。SMI 组与死亡和 MACE 的风险显著增加相关，但根据不同的定义，PMI 和 SMI 之间的 MACE 风险没有显著差异。
根据不同的 PMI 定义，PMI 和 SMI 与 MACE 风险增加相关，但与 PMI 无关的死亡风险增加无关。PMI 和 SMI 之间没有观察到 MACE 风险的显著差异。
