经皮冠状动脉介入治疗相关心肌梗死诊断标准研究

Diagnostic criteria of percutaneous coronary intervention-related myocardial infarction

目的探讨择期经皮冠状动脉介入治疗(PCI)术后PCI相关心肌梗死诊断标准[2012年美国心脏病学会杂志(JACC)及2013年心血管造影和介入协会(SCAI)共识]的差别,并比较其可行性,选择更符合临床实际的PCI相关心肌梗死的诊断标准。方法选择2011年8月至2014年11月解放军306医院心血管内科择期行PCI的住院患者510例为研究对象,按照2012年JACC及2013年SCAI共识的PCI相关心肌梗死诊断标准分组,观察并比较术后48 h内外周静脉血肌钙蛋白I(c Tn I)、肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)水平。结果根据JACC标准和SCAI标准,PCI相关心肌梗死的发生比例分别为7.1%(36/510)和3.3%(17/510)。SCAI标准诊断患者,除c Tn I外,CK、CK-MB也明显高于JACC标准诊断患者(P<0.05)。符合SCAI标准但不满足JACC标准的PCI相关心肌梗死者8例,其c Tn I、CK及CK-MB明显高于符合JACC标准但肌钙蛋白升高未达到SCAI标准的27例患者(P<0.05)。结论 2013年SCAI专家共识PCI相关心肌梗死定义临床可操作性强,更符合临床实际。

Objective To investigate the differences and feasibility of diagnostic criteria of percutaneous coronary intervention （PCI） related myocardial infarction between 2012 JACC consensus and 2013 SCAI consensus were compared to obtain the more appropriate diagnostic criteria of PCI-related myocardial infarction for the clinical practice. Methods A retrospective study was perfromed on 510 cases of hospitalized patients with coronary heart disease undergoing elective PCI from August 2011 to November 2014. Diagnosis of PCI-related myocardial infarction was made according to 2012 JACC consensus and 2013 SCAI consensus ,respectively. Detection of troponin I（ cTnI）, creatine kinase （CK）and creatine kinase isoenzyme（CK-MB） levels of the peripheral blood before and 48 hours after surgery were peformed to compare the differences between the groups. Results According to 2012 JACC consensus and 2013 SCAI consensus, the incidence of PCI-related myocardial infarction was 7.1% （36/510 ）and 3.3% （17/510）, respectively. Besides cTnI, CK, CK-MB in cases diagnosed according to 2013 SCAI consensus was also significantly higher than in the cases diagnosed according to 2012 JACC consensus about PCI-related myocardial infarction（P 〈0. 05）. There were 8 cases which meet the diagnostic criteria of 2013 SCAI consensus can not meet the 2012 JACC consensus of PCI-related myocardial infarction. Besides cTnl, CK, CK-MB was also significantly higher than in the other 27 eases diagnosed according to 2012 JACC consensus about PCI-related myocardial infarction. However, the elevation of troponin did not meet the 2013 SCAI expert consensus （P 〈 0. 05 ）. Conclusion The 2013 SCAI consensus for the diagnosis of PCI-related myocardial infarction is more appropriate for the clinical practice.