Talmor Nina, Graves Claire, Kozloff Sam, Major Vincent J, Xia Yuhe, Shah Binita, Babaev Anvar, Razzouk Louai, Rao Sunil V, Attubato Michael J, Feit Frederick, Slater James, Smilowitz Nathaniel R
Leon H. Charney Division of Cardiology, Department of Medicine (N.T., B.S., A.B., L.R., S.V.R., M.J.A., F.F., J.S., N.R.S.), New York University Grossman School of Medicine, NY.
Department of Medicine, Columbia University Medical Center, New York, NY (C.G.).
Circ Cardiovasc Interv. 2025 May;18(5):e014934. doi: 10.1161/CIRCINTERVENTIONS.124.014934. Epub 2025 Mar 31.
Myocardial injury detected after percutaneous coronary intervention (PCI) is associated with increased mortality. Predictors of post-PCI myocardial injury are not well established. The long-term prognostic relevance of post-PCI myocardial injury remains uncertain.
Consecutive adults aged ≥18 years with stable ischemic heart disease who underwent elective PCI at NYU Langone Health between 2011 and 2020 were included in a retrospective, observational study. Patients with acute myocardial infarction or creatinine kinase myocardial band (CKMB) or troponin concentrations >99% of the upper reference limit before PCI were excluded. All patients had routine measurement of CKMB concentrations at 1 and 3 hours post-PCI. Post-PCI myocardial injury was defined as a peak CKMB concentration >99% upper reference limit. Linear regression models were used to identify clinical factors associated with post-PCI myocardial injury. Cox proportional hazard models were generated to evaluate relationships between post-PCI myocardial injury and all-cause mortality at long-term follow-up.
Among 10 807 patients undergoing elective PCI, the median age was 67 years (interquartile range, 15.6), and 24.9% were of female sex. Post-PCI myocardial injury occurred in 1813 (16.8%) patients. Myocardial injury was less common among female than male patients (14.1% versus 17.7%, <0.001). Older age, longer lesion lengths, multivessel PCI, severe coronary calcification, and thrombectomy device use were independently associated with post-PCI myocardial injury with CKMB levels ≥99% upper reference limit. Over 46 071 patient-years of follow-up (mean 4.3 years), 472 patients died (4.4%). A greater proportion of patients with versus without post-PCI myocardial injury died during follow-up (7.9% versus 3.6%, <0.001). After adjustment for demographics and clinical covariates, post-PCI myocardial injury was associated with an excess hazard for long-term mortality (hazard ratio, 1.46 [95% CI, 1.20-1.78]).
Myocardial injury defined by elevated CKMB early after PCI is common and associated with all-cause, long-term mortality. More complex coronary anatomy is predictive of post-PCI myocardial injury.
经皮冠状动脉介入治疗（PCI）后检测到的心肌损伤与死亡率增加相关。PCI术后心肌损伤的预测因素尚未完全明确。PCI术后心肌损伤的长期预后相关性仍不确定。
纳入2011年至2020年在纽约大学朗格尼健康中心接受择期PCI的年龄≥18岁的连续成年稳定型缺血性心脏病患者，进行一项回顾性观察研究。排除急性心肌梗死患者或PCI术前肌酐激酶心肌型同工酶（CKMB）或肌钙蛋白浓度>参考上限99%的患者。所有患者在PCI术后1小时和3小时常规测量CKMB浓度。PCI术后心肌损伤定义为CKMB峰值浓度>参考上限99%。采用线性回归模型确定与PCI术后心肌损伤相关的临床因素。生成Cox比例风险模型以评估PCI术后心肌损伤与长期随访全因死亡率之间的关系。
在10807例接受择期PCI的患者中，中位年龄为67岁（四分位间距，15.6），女性占24.9%。1813例（16.8%）患者发生PCI术后心肌损伤。女性患者心肌损伤的发生率低于男性患者（14.1%对17.7%，<0.001）。年龄较大、病变长度较长、多支血管PCI、严重冠状动脉钙化和使用血栓切除术装置与CKMB水平≥参考上限99%的PCI术后心肌损伤独立相关。在超过46071患者年的随访（平均4.3年）中，472例患者死亡（4.4%）。PCI术后心肌损伤患者在随访期间死亡的比例高于未发生心肌损伤的患者（7.9%对3.6%，<0.001）。在调整人口统计学和临床协变量后，PCI术后心肌损伤与长期死亡率的额外风险相关（风险比，1.46[95%CI，1.20 - 1.78]）。
PCI术后早期CKMB升高所定义的心肌损伤很常见，且与全因长期死亡率相关。更复杂的冠状动脉解剖结构可预测PCI术后心肌损伤。
