Definitions of peri-procedural myocardial infarction and the association with one-year mortality: Insights from CHAMPION trials.
Definitions of peri-procedural myocardial infarction and the association with one-year mortality: Insights from CHAMPION trials.
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DOI：
10.1016/j.ijcard.2018.06.034
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发表时间：
2018-11-01
影响因子：
3.5
通讯作者：
CHAMPION PLATFORM and CHAMPION PCI Investigators
中科院分区：
文献类型：
--
作者：
Olivier CB;Sundaram V;Bhatt DL;Leonardi S;Lopes RD;Ding VY;Yang L;Stone GW;Steg PG;Gibson CM;Hamm CW;Price MJ;White HD;Desai M;Lynch DR Jr;Harrington RA;Mahaffey KW;CHAMPION PLATFORM and CHAMPION PCI Investigators
关于围手术期心肌梗死（PPMI）的适当定义及其与死亡率的关系存在争议。本研究旨在评估经皮冠状动脉介入治疗（PCI）后的1年生存率以及当代稳定型心绞痛（SA）或急性冠状动脉综合征（ACS）患者中不同定义的PMI与生存率的相关性。我们使用来自CHAMPION PLATFORM和CHAMPION PCI试验的数据，对接受PCI的患者进行单变量和多变量考克斯比例风险回归模型，以评估PCI后第一年的死亡风险。设盲的事件委员会裁定疑似PPMI，定义为生物标志物升高≥3×正常值上限（ULN）或新发Q波。我们通过CK-MB升高的幅度（[a] 3至<5× ULN，[B] 5至<10× ULN，[c] ≥10× ULN）或通过排除PCI前有心肌梗死（MI）证据的患者的第二种心肌梗死通用定义（UDMICK-MB）进一步分析了PPMI。在13，968名患者中，11%最初表现为SA，89%表现为ACS。1年死亡率为3.4%（SA：1.5%; ACS：3.6%）。6.3%的患者发生PPMI（3至<5× ULN：2.5%; 5至<10× ULN：2.1%; ≥10× ULN：1.6%; UDMICK-MB：2.7%）。多变量校正后，观察到PPMI患者的1年死亡率风险显著高于无PPMI患者（HR 2.35 [1.74-3.18]，p < 0.001; 3至<5× ULN：1.55 [0.92-2.62]，p = 0.10; 5至<10× ULN：1.22 [0.67-2.20]，p = 0.52; ≥10× ULN：4.78 [3.06-7.47]，p < 0.001; UDMICK-MB：2.19 [1.29-3.73]，p = 0.004）。PPMI发生在6.3%的患者中，与一年内死亡风险增加相关。如果仅定义为围手术期CK-MB升高<10× ULN且未对症状或缺血证据进行额外评价，则PPMI对生存率无显著影响。这些发现强调了PPMI对当代长期结局的重要性，以及其在临床试验规划和解释中的定义。
Controversies exist over the appropriate definition for peri-procedural myocardial infarction (PPMI) and its association with mortality. This study aims to evaluate one-year survival following percutaneous coronary intervention (PCI) and the association of different definitions of PPMI with survival among patients with stable angina (SA) or acute coronary syndrome (ACS) in the contemporary era. We used data from the CHAMPION PLATFORM and CHAMPION PCI trials of patients undergoing PCI and conducted univariable and multivariable Cox proportional hazard regression models to evaluate mortality risk during the first year after PCI. A blinded events committee adjudicated suspected PPMI defined by biomarker elevations ≥3× the upper limit of normal (ULN) or new Q-waves. We further analyzed PPMI by the magnitude of CK-MB elevation ([a] 3 to <5× ULN, [b] 5 to <10× ULN, [c] ≥10× ULN) or by the 2nd universal definition of myocardial infarction (UDMICK-MB) excluding patients with evidence of myocardial infarction (MI) prior to PCI. Of 13,968 patients, 11% initially presented with SA, and 89% with ACS. One-year mortality was 3.4% (SA: 1.5%; ACS: 3.6%). PPMI occurred in 6.3% of the patients (3 to <5× ULN: 2.5%; 5 to <10× ULN: 2.1%; ≥10× ULN: 1.6%; UDMICK-MB: 2.7%). After multivariable adjustment, a significantly higher risk of one-year mortality was observed for patients with PPMI compared with patients without PPMI (HR 2.35 [1.74–3.18], p < 0.001; 3 to <5× ULN: 1.55 [0.92–2.62], p = 0.10; 5 to <10× ULN: 1.22 [0.67–2.20], p = 0.52; ≥10× ULN: 4.78 [3.06–7.47], p < 0.001; UDMICK-MB: 2.19 [1.29–3.73], p = 0.004). PPMI occurred in 6.3% of the patients and was associated with increased risk of death within one year. Survival was not significantly impacted by PPMI if defined by periprocedural CK-MB elevations <10× ULN alone and without additional evaluation of symptoms or evidence of ischemia. These findings highlight the importance of PPMI for long-term outcome in the contemporary era and of its definition in the planning and interpretation of clinical trials.
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影响因子：
4.8
作者：
Leonardi, Sergio;Mahaffey, Kenneth W.;Bhatt, Deepak L.
通讯作者：
Bhatt, Deepak L.
影响因子：
158.5
作者：
Bhatt, Deepak L.;Stone, Gregg W.;Harrington, Robert A.
通讯作者：
Harrington, Robert A.
考虑冠状动脉血运重建后临床相关心肌梗塞的新定义：心血管血管造影和干预协会（SCAI）的专家共识文件（SCAI）。
影响因子：
24
作者：
Moussa, Issam D.;Klein, Lloyd W.;Shah, Binita;Mehran, Roxana;Mack, Michael J.;Brilakis, Emmanouil S.;Reilly, John P.;Zoghbi, Gilbert;Holper, Elizabeth;Stone, Gregg W.
通讯作者：
Stone, Gregg W.
影响因子：
37.8
作者：
Cavender, Matthew A.;Bhatt, Deepak L.;Harrington, Robert A.
通讯作者：
Harrington, Robert A.
影响因子：
4.1
作者：
Leonardi, Sergio;Lopes, Renato D.;Mahaffey, Kenneth W.
通讯作者：
Mahaffey, Kenneth W.