관상동맥중재술과 연관된 심근경색증의 정의

Abstract

Background: The criteria for clinically relevant myocardial infarction (MI) associated with percutaneous coronary intervention (PCI) remains debatable. We aimed to determine the criteria of periprocedural MI associated with long-term mortality and with mortality rate similar to spontaneous MI. Methods: From four prospective PCI registries, 17,190 patients with negative creatine kinase-MB (CK-MB) elevation at baseline who underwent drug-eluting stenting were included. Chest pain, cardiac enzyme, electrocardiographic changes, and angiographic mechanism were prospectively collected and independently adjudicated. Periprocedural MI was defined as post-PCI CK-MB elevation ≥3 times the upper reference limit (URL). Spontaneous MI was defined as spontaneous, non-PCI-related CK-MB elevation. The primary endpoint was all-cause mortality at a median follow-up of 4.5 years (interquartile range: 3.2, 5.2 years). Results: The criteria of clinically relevant periprocedural MI associated with a higher risk of long-term mortality was CK-MB elevation ≥3 times the URL plus new-onset Q wave or angiographic major vessel complications or CK-MB elevation ≥10 times the URL (incidence, 2.9%; adjusted hazard ratio, 1.61; 95% confidence interval, 1.20-2.14; P=0.001). However, standardized mortality rate of periprocedural MI achieving new criteria was lower than that of spontaneous MI (2.28 per 100 person-year versus 6.14 per 100 person-year). CK-MB threshold for periprocedural MI with mortality similar to spontaneous MI was 58 times the URL. Conclusions: This study provided criteria for periprocedural MI with a higher risk of long-term mortality based on the combination of cardiac enzyme elevation and supportive clinical features. Nevertheless, clinically relevant periprocedural MI showed lower mortality rate than spontaneous MI.