复杂经皮冠状动脉介入治疗与非复杂经皮冠状动脉介入治疗患者的围手术期心肌梗死。

Periprocedural myocardial infarction in patients undergoing complex versus noncomplex percutaneous coronary intervention.

机构信息

Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.

Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II and CEINGE S.C.a r.l. Advanced Biotechnology, Naples, Italy.

出版信息

Catheter Cardiovasc Interv. 2023 Aug;102(2):212-220. doi: 10.1002/ccd.30749. Epub 2023 Jun 19.

DOI:10.1002/ccd.30749

PMID:37337462

Abstract

BACKGROUND

Limited data are available on the risk of periprocedural myocardial infarction (MI) in patients undergoing complex versus noncomplex percutaneous coronary intervention (PCI).

METHODS

We assessed the risk of periprocedural MI according to the fourth Universal definition of myocardial infarction (UDMI) and several other criteria among patients undergoing elective PCI in a prospective, single-center registry. Complex PCI included at least one of the following: 3 coronary vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, treatment of chronic total occlusion, and use of rotational atherectomy.

RESULTS

Between 2017 and 2021, we included 1010 patients with chronic coronary syndrome, of whom 226 underwent complex PCI (22.4%). The rate of periprocedural MI according to the fourth UDMI was significantly higher in complex compared to noncomplex PCI patients (26.5% vs. 14.5%, p < 0.001). Additionally, periprocedural MI was higher in the complex PCI group using SCAI (4% vs. 1.1%, p = 0.009), ARC-2 (13.7% vs. 8.0%, p = 0.013), ISCHEMIA (5.8% vs. 1.7%, p = 0.002), and EXCEL criteria (4.9% vs. 2.0%, p = 0.032). SYNTAX periprocedural MI occurred at low rates in both groups (0.9% vs. 0.6%, p = 0.657). Complex PCI was an independent predictor of the fourth UDMI periprocedural MI (odds ratio [OR] 1.54, 95% confidence interval [CI]: 1.04-2.27, p = 0.031).

CONCLUSIONS

In patients with chronic coronary syndrome undergoing elective PCI, complex PCI is associated with a significantly higher risk of periprocedural MI using multiple definitions. These findings highlight the importance of considering upfront this risk in the planning of complex PCI procedures.

摘要

背景

在接受复杂与非复杂经皮冠状动脉介入治疗（PCI）的患者中，关于围手术期心肌梗死（MI）风险的相关数据有限。

方法

我们在一项前瞻性、单中心注册研究中，根据第四版心肌梗死通用定义（UDMI）和其他几项标准，评估了择期 PCI 患者围手术期 MI 的风险。复杂 PCI 包括以下至少一项：治疗 3 个冠状动脉血管、植入≥3 个支架、治疗≥3 个病变、分叉病变植入 2 个支架、总支架长度＞60mm、治疗慢性完全闭塞病变和使用旋磨术。

结果

2017 年至 2021 年，我们纳入了 1010 例慢性冠状动脉综合征患者，其中 226 例行复杂 PCI（22.4%）。根据第四版 UDMI，复杂 PCI 患者的围手术期 MI 发生率明显高于非复杂 PCI 患者（26.5% vs. 14.5%，p<0.001）。此外，在使用 SCAI、ARC-2、ISCHEMIA 和 EXCEL 标准时，复杂 PCI 组的围手术期 MI 发生率更高（分别为 4% vs. 1.1%，p=0.009；13.7% vs. 8.0%，p=0.013；5.8% vs. 1.7%，p=0.002；4.9% vs. 2.0%，p=0.032）。两组 SYNTAX 围手术期 MI 发生率均较低（分别为 0.9% vs. 0.6%，p=0.657）。复杂 PCI 是第四版 UDMI 围手术期 MI 的独立预测因素（比值比[OR]1.54，95%置信区间[CI]：1.04-2.27，p=0.031）。