慢性完全闭塞性病变经皮冠状动脉介入治疗相关心肌损伤的预测因素和预后。
Predictors and prognosis of PCI-related myocardial injury in chronic total occlusion.
机构信息
Dalian Medical University, Lushunkou District, No. 9, West section of Lushun South Road, 116041, Dalian, China.
Department of cardiology, The People's Hospital of Liaonig Province, No.33, Wenyi road, Shenhe District, 110000, Shenyang City, Liaoning Province, China.
出版信息
BMC Cardiovasc Disord. 2022 Oct 29;22(1):454. doi: 10.1186/s12872-022-02887-0.
BACKGROUND
Periprocedural myocardial injury (PMI) is associated with major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI). However, the incidence predictors and prognosis of PMI in chronic total occlusion (CTO) undergoing PCI remains unclear.
METHOD
To evaluate the predictors and prognostic impact of PMI following PCI in patients with CTO. We consecutively enrolled 132 individuals and 8 of whom with procedural failure were excluded in this study. Thus, a total of 124 CTO patients successfully received PCI were included in this study. And patients were divided into the PMI group (n = 42) and the non-PMI group (n = 82) according to their c-TnI levels measured after procedure. The baseline and angiographic characteristics of the two groups were compared. The predictors of PMI and the correlation between PMI and MACE were investigated.
RESULTS
Overall, PMI occurred in 42 patients (33.9%). Comparing with control group, PMI group had more diabetes (54.8% vs. 31.7%,P = 0.013) and dyslipidemia (54.8% vs. 13.4%, P＜0.001). Also, there were significant differences between the two groups in left ventricular ejection fraction(43.2 ± 7.2 vs 47.2 ± 8.0, P = 0.027), prior myocardial infarction(54.8%vs43.1%, P = 0.020), prior PCI(57.1% vs 22.0%, P＜0.001) and prior CABG(14.3% vs 2.4%, P = 0.011). Also, patients with PMI had more calcified lesions (52.4% vs 24.4%, P = 0.002) and were more likely to have multivessel disease (71.4% vs 35.4%, P＜0.001). In addition, patients in the PMI group had higher J-CTO scores (3.3 ± 1.0 vs 1.9 ± 0.5, P＜0.001) and were more likely to have wire-crossing difficulties (64.3% vs 37.8%, P = 0.005), require more use of retrograde approach (38.1% vs 7.3%, P＜0.001) and have more procedural complications (19.0% vs 2.4%, P = 0.003). In the multivariate analysis, multivessel artery disease (odd ratio [OR], 4.347;95% confidence interval [CI], 1.601- 11.809;P = 0.004), retrograde approach (OR, 4.036; 95%CI, 1.162- 14.020;P = 0.028) and the presence of procedural complications (OR, 16.480;95%CI, 2.515-107.987;P = 0.003) were predictors of PMI.
CONCLUSION
The incidence of PMI in CTO patients after PCI was 33.9%. Multivessel artery disease, retrograde approach, and the presence of procedural complications were predictors of PMI after CTO-PCI. Patients who develop PMI tend to have a poorer clinical prognosis and more MACE than those who do not develop PMI.
背景
经皮冠状动脉介入治疗（PCI）后围手术期心肌损伤（PMI）与主要不良心血管事件（MACE）相关。然而，慢性完全闭塞（CTO）PCI 后 PMI 的发生率预测因素和预后仍不清楚。
方法
评估 CTO 患者 PCI 后 PMI 的发生率预测因素和预后影响。我们连续纳入了 132 名患者，其中 8 名患者因手术失败而被排除在外。因此，共有 124 名 CTO 患者成功接受了 PCI 治疗。根据术后测量的 c-TnI 水平，患者被分为 PMI 组（n=42）和非-PMI 组（n=82）。比较两组的基线和血管造影特征。研究了 PMI 的预测因素以及 PMI 与 MACE 之间的相关性。
结果
总体而言，42 名患者（33.9%）发生了 PMI。与对照组相比，PMI 组有更多的糖尿病（54.8% vs. 31.7%，P=0.013）和血脂异常（54.8% vs. 13.4%，P＜0.001）。此外，两组在左心室射血分数（43.2±7.2 与 47.2±8.0，P=0.027）、既往心肌梗死（54.8% vs. 43.1%，P=0.020）、既往 PCI（57.1% vs. 22.0%，P＜0.001）和既往 CABG（14.3% vs. 2.4%，P=0.011）方面存在显著差异。此外，PMI 患者中钙化病变更多（52.4% vs. 24.4%，P=0.002），多血管病变更多（71.4% vs. 35.4%，P＜0.001）。此外，PMI 组的 J-CTO 评分更高（3.3±1.0 与 1.9±0.5，P＜0.001），并且更有可能出现导丝交叉困难（64.3% vs. 37.8%，P=0.005）、需要更多逆行途径（38.1% vs. 7.3%，P＜0.001）和发生更多的手术并发症（19.0% vs. 2.4%，P=0.003）。多变量分析显示，多血管病变（比值比 [OR]，4.347；95%置信区间 [CI]，1.601-11.809；P=0.004）、逆行途径（OR，4.036；95%CI，1.162-14.020；P=0.028）和手术并发症的存在（OR，16.480；95%CI，2.515-107.987；P=0.003）是 PMI 的预测因素。
结论
CTO 患者 PCI 后 PMI 的发生率为 33.9%。多血管病变、逆行途径和手术并发症的存在是 CTO-PCI 后 PMI 的预测因素。发生 PMI 的患者临床预后较差，MACE 发生率高于未发生 PMI 的患者。
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