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
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）。
DOI：
10.1016/j.jacc.2013.08.720
复制
发表时间：
2013-10-22
影响因子：
24
通讯作者：
Stone, Gregg W.
中科院分区：
文献类型：
--
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.
对于冠状动脉血运重建后心肌梗死（MI）的诊断，已经提出了多种定义。 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，这些阈值具有不确定的预后重要性。此外，对于这两种 MI 类型，建议选择 cTn 作为生物标志物，但其预后意义的验证不如 CK-MB。广泛采用与随后的不良事件（例如死亡或心力衰竭）没有明确联系的 MI 定义可能会对设备和治疗的适当评估产生严重后果，可能会影响临床护理途径，并可能导致对医生能力的误解。与其使用对小程度肌坏死敏感的 MI 定义（根据当代大规模研究，这种情况的发生不太可能产生重要的临床后果），而是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”。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、患者护理和质量结果评估。
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 the 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 using 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.
登录
查看更多内容
影响因子：
37.8
作者：
Bangalore, Sripal;Pursnani, Seema;Bagos, Pantelis G.
通讯作者：
Bagos, Pantelis G.
影响因子：
2.8
作者：
Brandt, RR;Filzmaier, K;Hanrath, P
通讯作者：
Hanrath, P
影响因子：
37.8
作者：
Damman, Peter;Wallentin, Lars;de Winter, Robbert J.
通讯作者：
de Winter, Robbert J.
影响因子：
37.8
作者：
Ellis, SG;Chew, D;Topol, EJ
通讯作者：
Topol, EJ
影响因子：
2.8
作者：
Feldman, Dmitriy N.;Minutello, Robert M.;Wong, S. Chiu
通讯作者：
Wong, S. Chiu