Consideration of a New Definition of Clinically Relevant Myocardial Infarction After Coronary Revascularization: An Expert Consensus Document From the Society for Cardiovascular Angiography and Interventions (SCAI)
Consideration of a New Definition of Clinically Relevant Myocardial Infarction After Coronary Revascularization: An Expert Consensus Document From the Society for Cardiovascular Angiography and Interventions (SCAI)
复制标题
DOI：
10.1002/ccd.25135
复制
发表时间：
2014-01-01
影响因子：
2.3
通讯作者：
Stone, Gregg W.
中科院分区：
文献类型：
--
作者：
Moussa, Issam D.;Klein, Lloyd W.;Stone, Gregg W.
冠状动脉血运重建术后心肌梗死的诊断有许多定义。MI的通用定义指定了用于定义经皮冠状动脉介入治疗（PCI）相关MI（4a型）和冠状动脉旁路移植术（CABG）相关MI（5型）的术后生物标志物阈值，其预后重要性不确定。此外，对于两种类型的MI，建议将cTn作为选择的生物标志物，其预后意义的验证不及CK-MB。广泛采用与后续不良事件（如死亡或心力衰竭）无明确关联的MI定义可能对器械和治疗的适当评估产生严重后果，可能影响临床护理路径，并可能导致对医生能力的误解。建议使用与临床研究中后续不良事件密切相关的生物标志物升高阈值水平来定义临床相关MI，而不是采用对轻度肌坏死敏感的MI定义（基于当代大规模研究，其发生不太可能具有重要的临床后果）。本文件介绍了冠状动脉血运重建（PCI或CABG）后“临床相关MI”的新定义，适用于临床试验、患者护理和质量结局评估。(c)2013 Wiley Periodicals，Inc.
Numerous definitions have been proposed for the diagnosis of myocardial infarction (MI) after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention (PCI)-related MI (type 4a) and coronary artery bypass grafting (CABG)-related MI (type 5) which are of uncertain prognostic importance. In addition, for both MI types cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK-MB. Widespread adoption of a MI definition not clearly linked to subsequent adverse events such as mortality or heart failure may have serious consequences for the appropriate assessment of devices and therapies, may affect clinical care pathways, and may result in misinterpretation of physician competence. Rather than employing an MI definition sensitive for small degrees of myonecrosis (the occurrence of which, based on contemporary large-scale studies, are unlikely to have important clinical consequences), it is instead recommended that a threshold level of biomarker elevation which has been strongly linked to subsequent adverse events in clinical studies be used to define a clinically relevant MI. The present document introduces a new definition for "clinically relevant MI" after coronary revascularization (PCI or CABG) which is applicable for use in clinical trials, patient care, and quality outcomes assessment. (c) 2013 Wiley Periodicals, Inc.