Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; State Key Laboratory of Cardiovascular Disease, Beijing, China.
Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
JACC Cardiovasc Interv. 2021 Aug 9;14(15):1623-1634. doi: 10.1016/j.jcin.2021.05.006.
The aim of this study was to: 1) assess the relationship of different thresholds of creatine kinase-myocardial band (CK-MB) and cardiac troponin with subsequent mortality; and 2) evaluate the prognostic significance of periprocedural myocardial infarction (PMI) according to various definitions of myocardial infarction in patients with left main (LM) coronary artery disease.
The magnitude of postprocedural biomarker elevation representing a clinically meaningful PMI after percutaneous coronary intervention (PCI) is controversial.
A total of 4,013 consecutive patients undergoing LM PCI at a single center from January 2004 to December 2016 were enrolled. CK-MB and cardiac troponin I (cTnI) were routinely collected at baseline and at frequent intervals between 8 and 48 hours after PCI. The primary and secondary outcomes were the covariate-adjusted 3-year rates of cardiovascular (CV) and all-cause mortality, respectively.
The 3-year rate of CV mortality progressively increased with higher peak CK-MB values. CV mortality was first independently predicted by postprocedural CK-MB 3 to 5 times the upper reference limit (URL) (adjusted hazard ratio [aHR]: 2.93; 95% confidence interval [CI]: 1.02-8.40), whereas all-cause death was independently predicted only by CK-MB ≥ 10 × URL (aHR: 3.25; 95% CI: 1.37-7.70). In contrast, no level of peak postprocedural cTnI was associated with CV or all-cause death. PMI by the Society for Cardiovascular Angiography and Interventions (SCAI), Academic Research Consortium-2 (ARC-2), and fourth universal definition of myocardial infarction (UDMI) occurred in 1.3%, 3.1%, and 5.1% of patients, respectively. The SCAI definition was significantly associated with 3-year CV mortality (aHR: 4.93; 95% CI: 1.92-12.69) and all-cause mortality (aHR: 3.11; 95% CI: 1.33-7.27), whereas the ARC-2 and fourth UDMI definitions were not.
In a large cohort of consecutive patients undergoing LM PCI, intermediate (≥3 × URL) and high (≥10 × URL) levels of peak postprocedural CK-MB independently predicted 3-year CV and all-cause mortality, respectively, whereas even large elevations of post-PCI cTnI did not. The SCAI definition (but not the ARC-2 or fourth UDMI) of PMI was independently associated with mortality after LM PCI.
本研究旨在：1）评估不同肌酸激酶同工酶-MB（CK-MB）和心肌肌钙蛋白水平与随后死亡率之间的关系；2）根据左主干（LM）冠状动脉疾病患者心肌梗死的不同定义，评估围术期心肌梗死（PMI）的预后意义。
经皮冠状动脉介入治疗（PCI）后生物标志物升高的幅度代表具有临床意义的 PMI，目前仍存在争议。
共纳入 2004 年 1 月至 2016 年 12 月在单中心接受 LM PCI 的 4013 例连续患者。在基线和 PCI 后 8 至 48 小时之间的频繁间隔常规采集 CK-MB 和心肌肌钙蛋白 I（cTnI）。主要和次要终点分别为校正协变量后的 3 年心血管（CV）和全因死亡率。
随着 CK-MB 峰值的升高，3 年 CV 死亡率逐渐增加。术后 CK-MB 升高至参考上限（URL）的 3 至 5 倍与 CV 死亡率独立相关（校正后的危险比[HR]：2.93；95%置信区间[CI]：1.02-8.40），而全因死亡仅与 CK-MB ≥ 10×URL 相关（HR：3.25；95%CI：1.37-7.70）。相比之下，没有任何水平的 CK-MB 峰值与 CV 或全因死亡相关。根据心血管造影和介入学会（SCAI）、学术研究联合会-2（ARC-2）和心肌梗死的第四通用定义（UDMI），PMI 的发生率分别为 1.3%、3.1%和 5.1%。SCAI 定义与 3 年 CV 死亡率（HR：4.93；95%CI：1.92-12.69）和全因死亡率（HR：3.11；95%CI：1.33-7.27）显著相关，而 ARC-2 和第四 UDMI 定义则没有。
在接受 LM PCI 的大量连续患者队列中，中等（≥3×URL）和高（≥10×URL）水平的 CK-MB 峰值独立预测 3 年 CV 和全因死亡率，而即使是 PCI 后 cTnI 的大幅升高也不预测。SCAI 定义（而不是 ARC-2 或第四 UDMI）的 PMI 与 LM PCI 后的死亡率独立相关。
