Ferrante Arnaud, Guedeney Paul, Silvain Johanne, Zeitouni Michel, Collet Jean-Philippe
Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie, Pitié Salpêtrière (AP-HP), 75013 Paris, France.
Rev Cardiovasc Med. 2022 Oct 18;23(10):351. doi: 10.31083/j.rcm2310351. eCollection 2022 Oct.
One of the most frequent complications following coronary revascularization is cardiac myonecrosis characterized by an elevation of cardiac biomarkers, particularly with the implementation of high-sensitivity cardiac troponin. In the last decades, various definitions of periprocedural myocardial injury and infarction have been proposed, based on different cardiac biomarkers, various thresholds, and the need for additional ischemic features. In this review, we aim at providing insights on the mechanisms involved in periprocedural myocardial injury and infarction following percutaneous coronary intervention or coronary artery bypass grafting, the strengths and limitations of the available definitions and their clinical implications. We also provide an updated description of preventive strategies that have been evaluated in randomized controlled trials to avoid these complications as well as patient-level and lesion-level risk factors to better anticipate and rebalance the indication for coronary revascularization and plan adequate post-procedure monitoring.
冠状动脉血运重建术后最常见的并发症之一是心肌坏死，其特征是心脏生物标志物升高，尤其是在采用高敏心肌肌钙蛋白检测时。在过去几十年中，基于不同的心脏生物标志物、各种阈值以及是否需要额外的缺血特征，人们提出了围手术期心肌损伤和梗死的各种定义。在本综述中，我们旨在深入探讨经皮冠状动脉介入治疗或冠状动脉旁路移植术后围手术期心肌损伤和梗死所涉及的机制、现有定义的优缺点及其临床意义。我们还提供了在随机对照试验中评估过的预防策略的最新描述，以避免这些并发症，以及患者层面和病变层面的危险因素，以便更好地预测和重新权衡冠状动脉血运重建的适应症，并规划适当的术后监测。
