Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Ann Palliat Med. 2021 May;10(5):5055-5068. doi: 10.21037/apm-20-2355. Epub 2021 May 14.
β-blockers are indicated in several cardiovascular diseases. However, data are limited on their effect on the periprocedural myocardial injury (PMI) incidence. This study was designed to evaluate the impact of using β-blockers before elective percutaneous coronary intervention (PCI) on PMI incidence.
This study included 4,027 patients who underwent elective PCI and had no elevated serum troponin I (TnI) or creatine kinase-MB (CK-MB) levels before PCI. Patients were divided into four groups based on gender and age (cut-off point 75 years). Serum TnI and CK-MB levels were measured before and every eight hours after the procedure. PMI was defined as postprocedural TnI or CK-MB ≥5 times the upper limits of normal (ULN) values. Logistic regression analysis including factors such as age, sex, prior β-blocker therapy, previous MI, length of implanted stents, characteristics of lesion and so on was performed to assess the effects of prior β-blocker therapy on the incidence of PMI.
In 2,332 male patients <75 years old, PMI incidence was higher in the β-blocker pre-usage subgroup than the no β-blocker pre-usage subgroup (16.4% vs. 11.7%, respectively; P=0.001). For the female patients ≥75 years old, the β-blocker pre-usage subgroup had a lower PMI incidence compared with the no β-blocker pre-usage subgroup (18.2% vs. 31.7%, respectively; P=0.012). In logistic regression analysis, the total length of implanted stents was a risk factor for PMI incidence in all patients. Also, β-blocker pre-usage was an independent risk factor for PMI in male patients <75 years old (HR =1.424, 95% CI: 1.088-1.864; P=0.01). However, we did not observe a significant effect in female patients ≥75 years old.
Our study indicates that the PCI-PMI association depends on age and gender groups, β-blocker use before PCI is associated with increased PMI incidence in male patients <75 years old.
β受体阻滞剂在多种心血管疾病中均有应用。然而，其在围手术期心肌损伤（PMI）发生率方面的作用的数据有限。本研究旨在评估择期经皮冠状动脉介入治疗（PCI）前使用β受体阻滞剂对 PMI 发生率的影响。
本研究纳入了 4027 名接受择期 PCI 且 PCI 前血清肌钙蛋白 I（TnI）或肌酸激酶同工酶-MB（CK-MB）水平无升高的患者。根据性别和年龄（截断点 75 岁）将患者分为四组。在术前和术后每 8 小时测量血清 TnI 和 CK-MB 水平。PMI 定义为术后 TnI 或 CK-MB 升高≥5 倍正常值上限（ULN）。使用包括年龄、性别、既往β受体阻滞剂治疗、既往心肌梗死、植入支架长度、病变特征等因素的 logistic 回归分析评估术前使用β受体阻滞剂对 PMI 发生率的影响。
在 2332 名＜75 岁的男性患者中，β受体阻滞剂预用药亚组的 PMI 发生率高于无β受体阻滞剂预用药亚组（分别为 16.4%和 11.7%；P=0.001）。对于≥75 岁的女性患者，β受体阻滞剂预用药亚组的 PMI 发生率低于无β受体阻滞剂预用药亚组（分别为 18.2%和 31.7%；P=0.012）。在 logistic 回归分析中，所有患者中植入支架的总长度是 PMI 发生率的危险因素。此外，β受体阻滞剂预用药是＜75 岁男性患者发生 PMI 的独立危险因素（HR=1.424，95%CI：1.088-1.864；P=0.01）。然而，在≥75 岁的女性患者中，我们并未观察到显著影响。
本研究表明，PCI-PMI 相关性取决于年龄和性别群体，PCI 前使用β受体阻滞剂与＜75 岁男性患者的 PMI 发生率增加相关。
