Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions
Prognostic Impact of Periprocedural Myocardial Infarction in Patients Undergoing Elective Percutaneous Coronary Interventions
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DOI：
10.1161/circinterventions.118.006752
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发表时间：
2018-12-01
影响因子：
5.6
通讯作者：
Kastrati, Adnan
中科院分区：
文献类型：
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作者：
Koskinas, Konstantinos C.;Ndrepepa, Gjin;Kastrati, Adnan
背景：经皮冠状动脉介入治疗后与预后相关的心肌损伤程度仍不明确。心血管血管造影和干预学会（SCAI）提出了标记的生物标志物升高来定义围手术期心肌梗死（PMI）。在高敏感性心肌肌钙蛋白时代，这些基于共识的阈值尚未得到验证。我们试图评估scai定义的PMI对预后的影响，并探讨择期经皮冠状动脉介入治疗后高敏心肌肌钙蛋白T （hs-cTnT）的最佳预后阈值。方法和结果：我们评估了在2个三级保健中心接受选择性经皮冠状动脉介入治疗的患者，并进行了一系列hs-cTnT测量。PMI定义为术后hs-cTnT峰值峰值，未升高患者为70倍参考上限（URL），基线水平升高患者为70倍参考上限（URL）。主要终点为1年全因死亡率。在8140例患者中，220例（2.7%）在1年内死亡。在多变量分析中，scai定义的PMI患者（n= 140; 1.7%）具有较高的1年死亡率（12.9% vs 2.5%，校正风险比4.10,95% CI 2.51-6.68， P< 0.001）和心脏死亡率（11.4% vs 2.1%，校正风险比4.21,95% CI 2.50-7.11， P< 0.001）。根据受试者工作特征分析，hs-cTnT的最佳预后阈值为bb10xurl， 14.6%的患者观察到。与scai定义的肌钙蛋白临界值相比，该阈值的特异性较低（85.7%对98.4%），但敏感性较高（25.4%对8.2%），预测1年死亡率的总体表现更好。结论：在接受择期经皮冠状动脉介入治疗的患者中，scai定义的PMI是一种独立的、高度特异性的、但不敏感的1年死亡率预测指标。在该队列中，在较低的hs-cTnT阈值（10倍URL）下观察到敏感性和特异性之间的最佳权衡。
BACKGROUND: The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions.METHODS AND RESULTS: We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT > 70x upper reference limit (URL) in patients with nonelevated ( 70x URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n= 140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51-6.68; P< 0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50-7.11; P< 0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was > 10xURL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin.CONCLUSIONS: In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10x URL) in this cohort.