Varying definitions for periprocedural myocardial infarction alter event rates and prognostic implications.
Varying definitions for periprocedural myocardial infarction alter event rates and prognostic implications.
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DOI：
10.1161/jaha.114.001086
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发表时间：
2014-10-30
影响因子：
5.4
通讯作者：
French JK
中科院分区：
文献类型：
--
作者：
Idris H;Lo S;Shugman IM;Saad Y;Hopkins AP;Mussap C;Leung D;Thomas L;Juergens CP;French JK
在过去十年中，围手术期心肌梗死（PMI）有几种定义，包括心血管造影和介入学会（SCAI）的定义，该定义要求与手术PMI标准一致的显著生物标志物升高。本研究的目的是检查基于定义的PMI频率，以及它们是否影响PMI与晚期死亡/心肌梗死（MI）率增加之间的相关性。我们研究了742例患者; 492例（66%）肌钙蛋白T（TnT）水平正常，250例（34%）TnT水平升高，但稳定或下降。使用2007年和2012年通用定义，分别有172例（23.2%）和99例（13.3%）患者发生PMI，而19例（2.6%）符合SCAI PMI定义（P<0.0001）。在使用2012年定义的PMI患者中，48例患者（48.5%）发生了≤1 mm的侧分支闭塞，这是PMI最常见的血管造影结果。根据2007年定义，与未患PMI的患者相比，患PMI的患者2年时的死亡/MI发生率为14.7% vs 10.1%（P=0.087），根据2012年定义为16.9% vs 10.3%（P=0.059），根据SCAI定义为29.4% vs 10.7%（P=0.015）。在这项研究中，根据SCAI定义，PMI与更频繁的晚期死亡/MI相关，所有使用2007年通用MI定义的PMI患者中，约有20%没有SCAI定义的PMI。将这些后一类患者归类为SCAI定义的无PMI患者并没有改变无PMI患者的死亡/MI率。
Periprocedural myocardial infarction (PMI) has had several definitions in the last decade, including the Society for Cardiovascular Angiography and Interventions (SCAI) definition, that requires marked biomarker elevations congruent with surgical PMI criteria. The aim of this study was to examine the definition‐based frequencies of PMI and whether they influenced the reported association between PMI and increased rates of late death/ myocardial infarction (MI). We studied 742 patients; 492 (66%) had normal troponin T (TnT) levels and 250 (34%) had elevated, but stable or falling, TnT levels. PMI, using the 2007 and the 2012 universal definition, occurred in 172 (23.2%) and in 99 (13.3%) patients, respectively, whereas 19 (2.6%) met the SCAI PMI definition (P<0.0001). Among patients with PMI using the 2012 definition, occlusion of a side branch ≤1 mm occurred in 48 patients (48.5%) and was the most common angiographic finding for PMI. The rates of death/MI at 2 years in patients with, compared to those without, PMI was 14.7% versus 10.1% (P=0.087) based on the 2007 definition, 16.9% versus 10.3% (P=0.059) based on the 2012 definition, and 29.4% versus 10.7% (P=0.015) based on the SCAI definition. In this study, PMI, according to the SCAI definition, was associated with more‐frequent late death/MI, with ≈20% of all patients, who had PMI using the 2007 universal MI definition, not having SCAI‐defined PMI. Categorizing these latter patients as SCAI‐defined no PMI did not alter the rate of death/MI among no‐PMI patients.