Association between the magnitude of periprocedural myocardial injury and prognosis in patients undergoing elective percutaneous coronary intervention.

Autor:	Zhou Y; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Chen Z; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Chen A; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Ma J; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Dai C; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Lu D; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Wu Y; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Li S; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Chen J; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Liu M; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Li C; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Lu H; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Qian J; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China., Ge J; Department of Cardiology, Zhongshan Hospital, Fudan University, 1609 Xietu Road, Shanghai 200032, P. R. China.; Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, P. R. China.
Jazyk:	angličtina
Zdroj:	European heart journal. Quality of care & clinical outcomes [Eur Heart J Qual Care Clin Outcomes] 2022 Nov 17; Vol. 8 (8), pp. 871-880.
DOI:	10.1093/ehjqcco/qcab103
Abstrakt:	Aims: This study aimed to investigate the prognostic implications of increased post-procedural cardiac troponin levels in patients undergoing elective percutaneous coronary intervention (PCI) and to define the threshold of prognostically relevant periprocedural myocardial injury (PMI). Methods and Results: A total of 3249 patients with normal baseline troponin levels referred for elective PCI were enrolled and followed up for a median period of 20 months. The primary endpoint was major adverse cardiovascular events (MACEs) comprising all-cause death, myocardial injury (MI), and ischaemic stroke. Post-PCI high-sensitivity cardiac troponin T (hs-cTnT) >99% upper reference limit (URL) occurred in 78.3% of the patients and did not increase the risk of MACEs [adjusted hazard ratio (adHR) 1.00, 95% confidence interval (CI) 0.58-1.74, P = 0.990], nor did 'major PMI', defined as post-PCI hs-cTnT >5× URL (adHR 1.30, 95% CI 0.76-2.23, P = 0.340). Post-PCI troponin >8× URL, with an incidence of 15.2%, started to show an association with a higher risk of MACEs (adHR 1.89, 95% CI 1.06-3.37, P = 0.032), mainly driven by myocardial infarction (adHR 2.38, 95% CI 1.05-5.38, P = 0.037) and ischaemic stroke (adHR 3.35, 95% CI 1.17-9.64, P = 0.025). Conclusion: In patients with normal baseline troponin values undergoing elective PCI, PMI defined as hs-cTnT >8× URL after PCI was more appropriate for identifying patients with an increased risk of MACEs, which may help guide clinical practice in this population. (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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