Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention
Impact of Periprocedural Myocardial Biomarker Elevation on Mortality Following Elective Percutaneous Coronary Intervention
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DOI：
10.1016/j.jcin.2019.07.014
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发表时间：
2019-10-14
影响因子：
11.3
通讯作者：
Vranckx, Pascal
中科院分区：
文献类型：
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作者：
Garcia-Garcia, Hector M.;McFadden, Eugene P.;Vranckx, Pascal
本研究旨在探讨经皮冠状动脉介入治疗（PCI）后肌酸激酶-心肌带（CK-MB）或心肌肌钙蛋白（cTn）的生物标志物升高与接受PCI治疗的稳定型心绞痛患者的死亡率之间的相关性，这些患者的基线值正常。然而，冠状动脉介入治疗后肌钙蛋白升高的预后意义仍有争议。方法：将5项当代冠状动脉支架试验和1项大型注册研究的患者水平数据汇总。比较基线生物标志物正常的稳定型心绞痛患者的死亡率，比较cTn和CK-MB具有和不具有不同临界值的患者。结果共有13，452例患者纳入本汇总分析。PCI后生物标志物升高的患者总体百分比为CK-MB 23.9%，cTn 68.4%。在两种检测均可用的患者队列中（n = 8，859），2.4%的患者CK-MB >= 5 x正常上限（ULN）且cTn >= 35 x ULN，而92%的患者CK-MB = 35 x ULN。相反，390例（64.8%）cTn >= 35 x ULN的患者没有CK-MB >= 5 x ULN。共有259例患者（1.9%）在1年时死亡; 20例（7.7%）CK-MB ≥ 5 x ULN，23例（8.8%）cTn ≥ 35 x ULN。在考克斯多变量分析中，术后CK-MB和cTn比值被强制纳入模型，年龄、既往心肌梗死、病变复杂性、高脂血症和术后CK-MB比值（>= 10）与1年死亡率增加相关。结论：在接受第二代药物洗脱支架治疗的稳定状态患者中，择期PCI后，CK-MB和cTn升高仍然很常见。经多因素校正后，PCI术后CK-MB升高会增加死亡率，而cTn升高与1年死亡率无关。(C)2019年由美国心脏病学会基金会。
OBJECTIVES This study sought to explore the association between biomarker elevation, with creatine kinase-myocardial band (CK-MB) or cardiac troponin (cTn), following percutaneous coronary intervention (PCI) and mortality in patients undergoing PCI for stable angina with normal baseline values.BACKGROUND Several studies have shown a strong association between post-PCI CK-MB elevation and subsequent mortality. However, the prognostic significance of troponin elevation following coronary intervention is still debated.METHODS Patient-level data from 5 contemporary coronary stent trials and 1 large registry were pooled. Mortality of patients with stable angina, with normal baseline biomarkers, was compared between patients with and those without different cutoff values of cTn and CK-MB.RESULTS A total of 13,452 patients were included in this pooled analysis. The overall percentage of patients with elevated biomarkers following PCI was 23.9% for CK-MB and 68.4% for cTn. In the patient cohort for whom both assays were available (n = 8,859), 2.4% had both CK-MB >= 5 x the upper limit of normal (ULN) and cTn >= 35 x ULN, while 92% had both CK-MB = 35 x ULN. Conversely, 390 of patients (64.8%) who had cTn >= 35 x ULN did not have CK-MB >= 5 x ULN. A total of 259 patients (1.9%) died at 1 year; 20 (7.7%) had CK-MB >= 5 x ULN, and 23 (8.8%) had cTn >= 35 x ULN. In the Cox multivariate analysis, in which the CK-MB and cTn ratios post-procedure were forced into the model, age, prior myocardial infarction, lesion complexity, hyperlipidemia, and CK-MB ratio (>= 10) post-procedure were associated with increased 1-year mortality.CONCLUSIONS Following elective PCI in patients in stable condition treated with second-generation drug-eluting stent, CK-MB and cTn elevations remain common. After multivariate adjustment, there was an increased mortality rate with elevation of CK-MB after PCI, whereas cTn elevation was not independently associated with mortality at 1 year. (C) 2019 by the American College of Cardiology Foundation.