Why the study?
The clinical significance of periprocedural myocardial injury in stable patients remains debated, having been addressed by numerous studies using varying definitions, thresholds, and biomarkers.
Does periprocedural myocardial injury predict adverse clinical outcomes in patients with stable angina pectoris undergoing elective PCI?
Does periprocedural myocardial injury predict adverse clinical outcomes in patients with stable angina pectoris undergoing elective PCI?
Periprocedural myocardial injury after elective percutaneous coronary intervention in stable angina pectoris does not predict adverse clinical outcomes at one year.
Post-PCI troponin elevation does not predict outcomes in stable angina; leaves open its prognostic value pending larger prospective studies.
Kontext: PeriprocedurĂĄlnĂ poĹĄkozenĂ myokardu a jeho vĂ˝znam pro klinickou praxi u stabilizovanĂ˝ch pa- cientĹŻ je stĂĄle pĹedmÄtem diskuse. TĂmto tĂŠmatem se za celĂŠ roky zabĂ˝vala Ĺada studiĂ s rĹŻznĂ˝mi definicemi, prahovĂ˝mi hodnotami a biomarkery. CĂlem naĹĄĂ studie bylo popsat vĂ˝slednĂ˝ klinickĂ˝ stav pacientĹŻ s periprocedurĂĄlnĂm poĹĄkozenĂm myokardu pomocĂ definic nejnovÄjĹĄĂch, 4. doporuÄenĂ˝ch postupĹŻ UDMI. Metody: Do monocentrickĂŠ studie bylo retrospektivnÄ zaĹazeno 238 pacientĹŻ po elektivnĂ perkutĂĄnnĂ koronĂĄrnĂ intervenci. Pacienti s periprocedurĂĄlnĂm poĹĄkozenĂm myokardu byli po vĂ˝konu srovnĂĄni s pacienty s normĂĄlnĂmi hodnotami troponinu z hlediska vĂ˝slednĂŠho klinickĂŠho stavu. Mezi primĂĄrnĂ sledovanĂŠ parametry patĹily ĂşmrtĂ, infarkt myokardu, cĂŠvnĂ mozkovĂĄ pĹĂhoda, refrakternĂ angina pectoris, revaskularizace cĂlovĂŠ lĂŠze a hospitalizace pro akutnĂ koronĂĄrnĂ syndrom do jednoho roku. VĂ˝sledky: PeriprocedurĂĄlnĂ poĹĄkozenĂ myokardu bylo zjiĹĄtÄno u 67,2 % (n = 160) pacientĹŻ. PoÄty lĂŠzĂ a stentĹŻ, celkovĂĄ dĂŠlka stentĹŻ, celkovĂ˝ prĹŻmÄr stentĹŻ, stav po dilataci, poÄty pĹekrĂ˝vajĂcĂch se stentĹŻ, stenty na bifurkacĂch a skĂłre SYNTAX byly statisticky vĂ˝znamnÄ vyĹĄĹĄĂ ve skupinÄ s poĹĄkozenĂm myokardu. UvedenĂŠ sledovanĂŠ parametry se vyskytly u 16 pacientĹŻ (11 ve skupinÄ s poĹĄkozenĂm myokardu a 5 v kontrolnĂ skupinÄ). BÄhem sledovĂĄnĂ nedoĹĄlo k ŞådnĂŠmu ĂşmrtĂ. PoprocedurĂĄlnĂ zvýťenĂ hodnot troponinu nebylo nijak spojeno se sledovanĂ˝mi parametry (11 vs. 5; p = 0,56). V KaplanovÄ-MeierovÄ analĂ˝ze se kĹivky sledovanĂ˝ch parametrĹŻ v obou skupinĂĄch od sebe nevzdalovaly (log rank test; 95% interval spolehlivosti [CI], p = 0,71). ZĂĄvÄry: Velikost a dĂŠlka stenu, dilatace po vĂ˝konu, pĹekrĂ˝vĂĄnĂ stentĹŻ a implantace stentĹŻ do lĂŠzĂ v bifurkacĂch zvyĹĄujĂ riziko poĹĄkozenĂ myokardu. PeriprocedurĂĄlnĂ poĹĄkozenĂ myokardu u stabilnĂ anginy pectoris nelze pouĹžĂt k predikci vĂ˝slednĂŠho stavu pacienta po jednom roce. © 2023, ÄKS.
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Sarılar et al. (2023) studied this question.
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