Department of Cardiovascular Medicine, Shinshu University Hospital, Nagano, Japan.
Department of Cardiovascular Medicine, Shinshu University Hospital, Nagano, Japan.
J Cardiol. 2023 Apr;81(4):364-372. doi: 10.1016/j.jjcc.2022.11.005. Epub 2022 Nov 12.
Percutaneous coronary intervention (PCI) in addition to guideline-directed medical therapy reduces the risk of spontaneous myocardial infarction (MI), urgent revascularization, and improves angina status; however, PCI is associated with an increased risk of periprocedural myocardial injury and MI. Numerous studies have investigated the mechanisms, predictors, and therapeutic strategies for periprocedural MI. Various definitions of periprocedural MI have been proposed by academic groups and professional societies requiring different cardiac biomarker thresholds and ancillary criteria for myocardial ischemia. The frequency and clinical significance of periprocedural MI substantially varies according to the definitions applied. In daily practice, accurate diagnosis of clinically-relevant periprocedural MI is essential because it may have a substantial impact on subsequent patient management. In the clinical trial setting, only clinically relevant periprocedural MI definitions should be applied as a clinical endpoint in order to avoid obscuring meaningful outcomes. In this review, we aim to summarize the mechanisms, predictors, frequency, and prognostic impact of periprocedural MI in patients undergoing PCI and to provide the current perspective on this issue.
经皮冠状动脉介入治疗（PCI）联合指南指导的药物治疗可降低自发性心肌梗死（MI）、紧急血运重建和改善心绞痛状态的风险；然而，PCI 与围手术期心肌损伤和 MI 的风险增加相关。许多研究已经探讨了围手术期 MI 的机制、预测因素和治疗策略。学术团体和专业协会提出了多种围手术期 MI 的定义，需要不同的心脏生物标志物阈值和心肌缺血的辅助标准。根据应用的定义，围手术期 MI 的频率和临床意义有很大差异。在日常实践中，准确诊断临床相关的围手术期 MI 至关重要，因为它可能对后续的患者管理产生重大影响。在临床试验中，只有应用临床相关的围手术期 MI 定义作为临床终点，才能避免掩盖有意义的结果。在这篇综述中，我们旨在总结接受 PCI 治疗的患者围手术期 MI 的机制、预测因素、频率和预后影响，并提供对此问题的当前观点。
