Wang Hao-Yu, Xu Bo, Dou Kefei, Guan Changdong, Song Lei, Huang Yunfei, Zhang Rui, Xie Lihua, Yang Weixian, Wu Yongjian, Qiao Shubin, Yang Yuejin, Gao Runlin, Stone Gregg W
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Soc Cardiovasc Angiogr Interv. 2023 Apr 3;2(3):100576. doi: 10.1016/j.jscai.2022.100576. eCollection 2023 May-Jun.
Periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) for left main coronary artery disease (LMCAD) may be particularly deleterious in patients with recent myocardial infarction (MI). We sought to determine the rates and prognostic relevance of PMI using different definitions and biomarker thresholds after PCI for LMCAD in patients with recent MI.
Between January 2004 and December 2016, 442 patients underwent PCI for LMCAD at a median of 3 days after presentation with MI. A total of 350 patients presented with elevated cardiac biomarker levels (349 with serial creatine kinase-myocardial band [CK-MB] and 219 with serial cardiac troponin I (cTnI) values) that were stable or falling before the PCI. In this cohort, PMI within 48 hours of PCI was adjudicated using Society for Cardiovascular Angiography & Interventions (SCAI), Academic Research Consortium 2 (ARC-2), and fourth Universal Definition of Myocardial Infarction (UDMI) criteria. The primary and secondary end points were 3-year rates of cardiovascular (CV) and all-cause death.
An incremental post-PCI rise in CK-MB starting at ≥10× the upper reference limit from baseline was significantly associated with 3-year CV death (adjusted hazard ratio [aHR], 7.96; 95% confidence interval [CI], 2.89-21.90), whereas CV death was not associated with any threshold elevation of cTnI. The frequencies of PMI according to the fourth UDMI, ARC-2, and SCAI definitions were 19.4%, 12.3%, and 8.6%, respectively. PMI by all 3 definitions was significantly associated with 3-year CV death, with the SCAI definition having the strongest relationship (aHR, 6.34; 95% CI, 2.47-16.27) compared with those of ARC-2 (aHR, 2.82; 95% CI, 1.15-6.96) and fourth UDMI (aHR, 2.65; 95% CI, 1.14-6.14).
In patients with recent MI undergoing PCI for LMCAD, an incremental elevation in postprocedural CK-MB of ≥10× the upper reference limit as a stand-alone measure was strongly predictive of 3-year CV and all-cause death, whereas no cTnI elevations of any level were prognostic. All 3 contemporary PMI definitions in widespread use were associated with 3-year mortality after PCI in this high-risk cohort, with the SCAI definition having the strongest relationship with subsequent death.
对于近期发生心肌梗死（MI）的患者，经皮冠状动脉介入治疗（PCI）治疗左主干冠状动脉疾病（LMCAD）后的围手术期心肌梗死（PMI）可能尤其有害。我们试图确定近期发生MI的患者在接受LMCAD的PCI治疗后，使用不同定义和生物标志物阈值时PMI的发生率及其预后相关性。
在2004年1月至2016年12月期间，442例患者在MI发病后中位3天接受了LMCAD的PCI治疗。共有350例患者的心脏生物标志物水平升高（349例有连续肌酸激酶心肌型同工酶[CK-MB]值，219例有连续心肌肌钙蛋白I[cTnI]值），且在PCI治疗前这些水平稳定或下降。在这个队列中，根据心血管造影和介入学会（SCAI）、学术研究联盟2（ARC-2）和心肌梗死的第四个通用定义（UDMI）标准判定PCI术后48小时内的PMI。主要和次要终点是3年心血管（CV）和全因死亡发生率。
PCI术后CK-MB从基线开始升高至≥正常上限的10倍与3年CV死亡显著相关（调整后风险比[aHR]，7.96；95%置信区间[CI]，2.89-21.90），而CV死亡与cTnI的任何阈值升高均无关。根据第四个UDMI、ARC-2和SCAI定义的PMI发生率分别为19.4%、12.3%和8.6%。所有3种定义的PMI均与3年CV死亡显著相关，与ARC-2定义（aHR，2.8;95%CI，1.15-6.96）和第四个UDMI定义（aHR，2.65;95%CI，1.14-6.14）相比，SCAI定义与CV死亡的关系最强（aHR，6.34;95%CI，2.47-16.27）。
在近期发生MI并接受LMCAD的PCI治疗的患者中，术后CK-MB升高至≥正常上限的10倍作为独立指标可强烈预测3年CV和全因死亡，而任何水平的cTnI升高均无预后意义。在这个高危队列中，广泛使用的所有3种当代PMI定义均与PCI术后3年死亡率相关，其中SCAI定义与随后死亡的关系最强。
