Impact of multi-vessel therapy to the risk of periprocedural myocardial injury after elective coronary intervention: exploratory study.
Impact of multi-vessel therapy to the risk of periprocedural myocardial injury after elective coronary intervention: exploratory study.
复制标题
多血管治疗对择期冠状动脉介入治疗后围手术期心肌损伤风险的影响：探索性研究
DOI：
10.1186/s12872-017-0501-x
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发表时间：
2017-02-27
影响因子：
2.1
通讯作者：
Ge JB
中科院分区：
文献类型：
--
作者：
Chen ZW;Yang HB;Chen YH;Ma JY;Qian JY;Ge JB
择期经皮冠状动脉介入治疗（PCI）围手术期心肌损伤（PMI）对冠心病（CAD）预后有重要影响。然而，PMI的发生是否与PCI策略或CAD严重程度等一系列可控因素相关尚不清楚。共入组了544例接受择期PCI的连续稳定型CAD患者。主要结局是PMI，定义为PCI后肌钙蛋白T至少有一个值高于第99百分位数参考上限。随访期间记录主要心脏不良事件（MACE），包括全因死亡、再次心肌梗死和靶血管血运重建。采用单因素和多因素分析评估PMI发生的预测因素。PMI的发生率为38.8%。与非PMI患者（n = 333）相比，PMI患者（n = 211）的病变血管更多，Gensini和Risk评分更高。PMI组MACE发生率为9.5%，高于PMI组的3.2%（P < 0.01）。PMI患者同时行多支血管PCI的比例较高（32.2% vs.10.5%，P < 0.01），支架植入率较高（1.8 ± 0.8 vs.1.4 ± 0.6，P < 0.01）。同时校正年龄、糖尿病、总胆固醇、病变血管数、Gensini评分和支架长度等因素后，多支血管PCI术的PMI风险仍增加84%（OR = 1.654，95% CI = 1.004-2.720，P < 0.05）。PMI现象多见于稳定期冠心病患者行多支血管PCI。多支血管国际治疗可增加择期PCI中发生PMI的风险。
Periprocedural myocardial injury (PMI) after elective percutaneous coronary intervention (PCI) significantly influences the prognosis of coronary artery disease (CAD). However, it was unclear whether the occurrence of PMI was associated with a series of controllable factors, such as PCI strategy or severity of CAD. A total of 544 consecutive stable CAD patients underwent elective PCI were enrolled. The main outcome is PMI, defined as troponin T after PCI was at least one value above the 99th percentile upper reference limit. Major adverse cardiac events (MACE), including all-cause death, repeat myocardial infarction and target vessel revascularization were record in the period of follow-up. Univariate and multivariate analysis was applied to assess predictors for the occurrence of PMI. The incidence of PMI was 38.8% in the study. Compared with non-PMI patients (n = 333), PMI patients (n = 211) had more diseased vessels, higher Gensini and Syntax score. Meanwhile, there were higher incidence of MACE in PMI groups (9.5% vs. 3.2%, P < 0.01). We found that PMI patients underwent higher proportion of multi-vessel PCI simultaneously (32.2% vs. 10.5%, P < 0.01) and had more stents implanted (1.8 ± 0.8 vs. 1.4 ± 0.6, P < 0.01). Importantly, after simultaneously adjusted by other factors (such as age, diabetes, total cholesterol, number of diseased vessels, Gensini score and stent length), the risk of PMI was still increased 84% by multi-vessel PCI independently (OR = 1.654, 95% CI = 1.004–2.720, P < 0.05). The phenomenon of PMI occurred more commonly in stable CAD patients underwent multi-vessel PCI. Multi-vessel international therapy could increase the risk of PMI in elective PCI.