Association between the magnitude of periprocedural myocardial injury and prognosis in patients undergoing elective percutaneous coronary intervention.
Association between the magnitude of periprocedural myocardial injury and prognosis in patients undergoing elective percutaneous coronary intervention.
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择期经皮冠状动脉介入治疗患者围手术期心肌损伤程度与预后的关系
DOI：
10.1093/ehjqcco/qcab103
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发表时间：
2022-11-17
影响因子：
5.2
通讯作者：
Ge, Junbo
中科院分区：
文献类型：
--
作者：
Zhou, You;Chen, Zhangwei;Chen, Ao;Ma, Jiaqi;Dai, Chunfeng;Lu, Danbo;Wu, Yuan;Li, Su;Chen, Jinxiang;Liu, Muyin;Li, ChenGuang;Lu, Hao;Qian, Juying;Ge, Junbo
本研究旨在研究接受择期经皮冠状动脉介入治疗（PCI）的患者术后心肌肌钙蛋白水平升高的预后意义，并定义与心脏相关的围手术期心肌损伤（PMI）的阈值。共有3249例基线肌钙蛋白水平正常的患者接受择期PCI，并进行了中位20个月的随访。主要终点是主要不良心血管事件（MACE），包括全因死亡、心肌损伤（MI）和缺血性卒中。78.3%的患者发生PCI后高敏心肌肌钙蛋白T（hs-cTnT）>99%参考上限（URL），未增加MACE的风险[校正风险比（adHR）1.00，95%置信区间（CI）0.58-1.74，P = 0.990]，也未增加“重大PMI”（定义为PCI后hs-cTnT >5× URL）（adHR 1.30，95% CI 0.76-2.23，P = 0.340）。PCI后肌钙蛋白>8× URL，发生率为15.2%，开始显示与MACE风险较高相关（adHR 1.89，95% CI 1.06-3.37，P = 0.032），主要由心肌梗死驱动（adHR 2.38，95% CI 1.05-5.38，P = 0.037）和缺血性卒中（adHR 3.35，95% CI 1.17-9.64，P = 0.025）。在接受择期PCI的基线肌钙蛋白值正常的患者中，PMI定义为PCI后hs-cTnT >8× URL更适合识别MACE风险增加的患者，这可能有助于指导该人群的临床实践。在多变量回归模型中，高敏感性心肌肌钙蛋白T高于8 × URL与长期不良临床结局风险增加相关。
This study aimed to investigate the prognostic implications of increased post-procedural cardiac troponin levels in patients undergoing elective percutaneous coronary intervention (PCI) and to define the threshold of prognostically relevant periprocedural myocardial injury (PMI). A total of 3249 patients with normal baseline troponin levels referred for elective PCI were enrolled and followed up for a median period of 20 months. The primary endpoint was major adverse cardiovascular events (MACEs) comprising all-cause death, myocardial injury (MI), and ischaemic stroke. Post-PCI high-sensitivity cardiac troponin T (hs-cTnT) >99% upper reference limit (URL) occurred in 78.3% of the patients and did not increase the risk of MACEs [adjusted hazard ratio (adHR) 1.00, 95% confidence interval (CI) 0.58–1.74, P = 0.990], nor did ‘major PMI’, defined as post-PCI hs-cTnT >5× URL (adHR 1.30, 95% CI 0.76–2.23, P = 0.340). Post-PCI troponin >8× URL, with an incidence of 15.2%, started to show an association with a higher risk of MACEs (adHR 1.89, 95% CI 1.06–3.37, P = 0.032), mainly driven by myocardial infarction (adHR 2.38, 95% CI 1.05–5.38, P = 0.037) and ischaemic stroke (adHR 3.35, 95% CI 1.17–9.64, P = 0.025). In patients with normal baseline troponin values undergoing elective PCI, PMI defined as hs-cTnT >8× URL after PCI was more appropriate for identifying patients with an increased risk of MACEs, which may help guide clinical practice in this population. In multivariate regression model, high-sensitivity cardiac troponin T above 8 × URL was associated with increased risk of longterm adverse clinical outcomes.
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影响因子：
5.4
作者：
Idris H;Lo S;Shugman IM;Saad Y;Hopkins AP;Mussap C;Leung D;Thomas L;Juergens CP;French JK
通讯作者：
French JK
DOI：
10.1016/s0140-6736(18)31923-8
发表时间：
2018-09-15
期刊：
Lancet (London, England)
影响因子：
--
作者：
Shah ASV;Anand A;Strachan FE;Ferry AV;Lee KK;Chapman AR;Sandeman D;Stables CL;Adamson PD;Andrews JPM;Anwar MS;Hung J;Moss AJ;O'Brien R;Berry C;Findlay I;Walker S;Cruickshank A;Reid A;Gray A;Collinson PO;Apple FS;McAllister DA;Maguire D;Fox KAA;Newby DE;Tuck C;Harkess R;Parker RA;Keerie C;Weir CJ;Mills NL;High-STEACS Investigators
通讯作者：
High-STEACS Investigators
影响因子：
11.3
作者：
Garcia-Garcia, Hector M.;McFadden, Eugene P.;Vranckx, Pascal
通讯作者：
Vranckx, Pascal
影响因子：
39.3
作者：
Ben-Yehuda, Ori;Chen, Shmuel;Stone, Gregg W.
通讯作者：
Stone, Gregg W.
DOI：
10.1161/circinterventions.118.006752
发表时间：
2018-12-01
影响因子：
5.6
作者：
Koskinas, Konstantinos C.;Ndrepepa, Gjin;Kastrati, Adnan
通讯作者：
Kastrati, Adnan