期刊
INTERNATIONAL JOURNAL OF CARDIOLOGY
卷 135, 期 1, 页码 60-65出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2008.03.033
关键词
Coronary artery disease; PTCA; Coronary stenting; Myocardial infarction
Background: Peri-procedural myocardial injury (PPI) during percutaneous coronary intervention (PCI) is common and associated with a poor outcome. No reliable angiographic or clinical predictors of PPI exist. We evaluated the ability of the SYNTAX score (SXscore), Gensini score, American Heart Association/American College of Cardiology (AHA/ACC) and Society for Cardiovascular Angiography and Intervention (SCAI) classifications to predict PPI. Methods: Consecutive patients were included from two existing databases of PCI. Patients with coronary bypass grafts or instent restenosis were excluded. PPI was defined as troponin I elevation (>1.0 mu g/L) at 6-24 h post-PCI. Delayed enhancement magnetic resonance imaging distinguished PPI territory in patients undergoing multi-vessel PCI. Quantitative coronary angiography was performed blinded to PPI. In total, 100 patients underwent PCI to 122 vessels. PPI occurred in 20/100 (20.0%) patients. Results: Mean patient SXscore was higher in patients with PPI (20.6 vs. 12.4, p=0.0001), however Gensini score was not significantly different (34.2 vs. 27.3, p=0.15). Mean vessel SXscore was higher in vessels associated with PPI (12.1 vs. 7.6, p= 0.002), but not different for vessel Gensini score (16.2 vs. 13.6, p=0.42). No vessels with AHA type A or B1 lesions were associated with PPI. Higher AHA scores (B2 and C) were associated with PPI (chi(2) for trend 11.6, p= 0.0007). SCAI scores were not predictive of PPI (chi(2) for trend 3.6, p= 0.06). By ROC analysis, a patient SXscore of >= 17 predicted PPI with a sensitivity of 75.0% and specificity of 70.0%. Conclusion: Higher SXscores are predictive of myocardial injury, whilst AHA type A and B1 lesions have a high negative predictive value for PPI. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
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