Han Zhang, Daniel Munhoz, Ward Heggermont, Paul Vermeersch, Peter Sinnaeve, Kazumasa Ikeda, Takuya Mizukami, Mitsuaki Matsumura, Jeroen Sonck, Hitoshi Matsuo, Tetsuya Amano, Hirohiko Ando, Masahiro Hada, Brian Ko, Simone Biscaglia, Fernando Rivero, Thomas Engstrøm, Antonio Maria Leone, Lokien X van Nunen, William F Fearon, Evald Høj Christiansen, Stephane Fournier, Liyew Desta, Toshiro Shinke, Andy Yong, Julien Adjedj, Javier Escaned, Masafumi Nakayama, Ashkan Eftekhari, Danielle Keulards, Frederik M Zimmermann, Ethan Korngold, Gianluca Campo, Frédéric Bouisset, Adriaan Wilgenof, Colin Berry, Damien Collison, Thomas W Johnson, Divaka Perera, Allen Jeremias, David Cohen, Ziad Ali, Gary S Mintz, Ajay J Kirtane, Margaret B McEntegart, Alexandra Popma, Jeff Popma, Ovidiu Dressler, Yader Sandoval, Bernard De Bruyne, Nils Johnson, Carlos Collet
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引用次数: 0
Abstract
Background: Whether periprocedural myocardial infarction (PMI) differs between focal and diffuse coronary physiology in the treated vessel remains unclear.
Objectives: To compare the incidence and prognostic impact of PMI after PCI for vessels with focal versus diffuse diseases defined by pullback pressure gradient (PPG).
Methods: We analyzed 855 patients undergoing PCI in the PPG Global registry. Physiological patterns of treated vessels were classified as focal or diffuse using PPG. PMI in the original registry was defined according to the Fourth Universal Definition of Myocardial Infarction (UDMI). The primary outcome of the current analysis was 1-year target vessel failure (TVF), a composite of cardiac death, spontaneous target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization.
Results: Fourth UDMI PMI was higher in patients with diffuse compared with focal physiology in the treated vessel (9.8% vs 5.9%; p=0.048). Troponin elevation ≥70 × URL(8.5% vs 4.8%; p=0.041) and PMI with flow-limiting angiographic complications (2.0% vs 0.2%; p=0.015) occurred more frequently after PCI for vessels with diffuse disease, whereas PMI with ischemic electrocardiographic changes was infrequent and similar between groups (0.8% vs 0.7%; p=1.000). 17 TVF occurred within 1 year; only troponin elevation ≥35 × URL accompanied by angiographic complications was associated with 1-year TVF.
Conclusions: PMI occurred more frequently after PCI for vessels with diffuse than focal coronary physiology, particularly phenotypes with higher troponin elevation or angiographic complications. Associations with 1-year TVF were observed only for PMI phenotypes incorporating angiographic complications; however, findings should be interpreted cautiously because TVF events were sparse.
背景：围手术期心肌梗死（PMI）在治疗血管的局灶性和弥漫性冠状动脉生理上是否不同尚不清楚。目的：比较由回拉压力梯度（PPG）定义的局灶性和弥漫性血管疾病PCI后PMI的发生率和预后影响。方法：我们分析了PPG Global注册的855例接受PCI的患者。利用PPG将处理后血管的生理模式分为局灶性和弥漫性。原始注册表中的PMI是根据心肌梗死第四通用定义（UDMI）定义的。当前分析的主要结局是1年靶血管衰竭（TVF），包括心源性死亡、自发性靶血管心肌梗死或缺血驱动的靶血管重建术。结果：血管弥漫性病变患者的第四UDMI PMI高于局灶性病变患者（9.8% vs 5.9%; p=0.048）。肌钙蛋白升高≥70 × URL（8.5% vs 4.8%, p=0.041）和PMI伴血流受限血管造影并发症（2.0% vs 0.2%, p=0.015）在弥漫性病变血管PCI后更为常见，而PMI伴缺血性心电图改变不常见，两组间相似（0.8% vs 0.7%, p=1.000）。17例TVF发生在1年内；只有肌钙蛋白升高≥35 × URL伴有血管造影并发症与1年TVF相关。结论：弥漫性冠状动脉生理比局灶性冠状动脉生理更容易发生PMI，特别是肌钙蛋白升高或血管造影并发症的表型。仅在伴有血管造影并发症的PMI表型中观察到与1年TVF的关联；然而，由于TVF事件较少，因此研究结果应谨慎解释。
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The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.
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