经皮冠状动脉介入治疗围术期心肌梗死对非 ST 段抬高型急性冠状动脉综合征老年患者死亡率的影响：FRASER 和 HULK 研究的 pooled 分析。

The impact of periprocedural myocardial infarction on mortality in older adults with non-ST-segment elevation acute coronary syndrome: a pooled analysis of the FRASER and HULK studies.

机构信息

Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona.

Department of Medical Science, University of Ferrara, Ferrara.

出版信息

J Cardiovasc Med (Hagerstown). 2021 Jul 1;22(7):546-552. doi: 10.2459/JCM.0000000000001146.

DOI:10.2459/JCM.0000000000001146

PMID:34076602

Abstract

AIMS

The prognostic implication of periprocedural myocardial infarction (MI) in older patients has been less investigated. The aim of this study is to assess the relationship between large periprocedural MI and long-term mortality in older patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI).

METHODS

This is a pooled analysis of older NSTEACS patients who were included in the FRASER and HULK studies. Periprocedural MI was defined in agreement with the Society for Cardiovascular Angiography and Interventions definition. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality. The predictors of periprocedural MI and the relationship with scales of physical performance, namely Short Physical Performance Battery and grip strength, were also investigated.

RESULTS

The study included 586 patients. Overall, periprocedural MI occurred in 24 (4.1%) patients. After a median follow-up of 1023 (740-1446) days, the primary endpoint occurred in 94 (16%) patients. After multivariable analysis, periprocedural MI emerged as an independent predictor of all-cause mortality (hazard risk 4.30, 95% confidence interval 2.27-8.12). This finding was consistent for cardiovascular mortality (hazard risk 7.45, 95% confidence interval 3.56-15.67). SYNTAX score, multivessel PCI and total stent length were independent predictors of large periprocedural MI. At hospital discharge, patients suffering from periprocedural MI showed poor values of Short Physical Performance Battery and grip strength as compared with others.

CONCLUSION

In a cohort of older NSTEACS patients undergoing PCI, large periprocedural MI occurred in around 4% of patients and was associated with long-term occurrence of all-cause and cardiovascular mortality.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov: NCT02324660 and NCT03021044.

摘要

目的

在老年患者中，围手术期心肌梗死（MI）的预后意义研究较少。本研究旨在评估经皮冠状动脉介入治疗（PCI）治疗非 ST 段抬高型急性冠状动脉综合征（NSTEACS）的老年患者中，大围手术期 MI 与长期死亡率之间的关系。

方法

这是一项纳入 FRASER 和 HULK 研究中老年 NSTEACS 患者的汇总分析。围手术期 MI 按照心血管造影和介入学会的定义进行定义。主要结局为全因死亡率。次要结局为心血管死亡率。还研究了围手术期 MI 的预测因素及其与身体表现量表（即短体表现电池和握力）的关系。

结果

研究纳入 586 例患者。总体而言，24 例（4.1%）患者发生围手术期 MI。中位随访 1023 天（740-1446 天）后，94 例（16%）患者发生主要终点事件。多变量分析后，围手术期 MI 是全因死亡率的独立预测因素（危险比 4.30，95%置信区间 2.27-8.12）。这一发现与心血管死亡率一致（危险比 7.45，95%置信区间 3.56-15.67）。SYNTAX 评分、多支血管 PCI 和总支架长度是大围手术期 MI 的独立预测因素。出院时，与其他患者相比，发生围手术期 MI 的患者短体表现电池和握力值较差。