BACKGROUND Numerous definitions for peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) and coronary bypass grafting (CABG) surgery exist. OBJECTIVES The purpose of this study was to investigate the PMI rates according to various definitions, their clinically relevant association with all-cause mortality at 10 years, and their impact on composite endpoints at 5 years in the SYNTAXES (Synergy between PCI with Taxus and Cardiac Surgery Extended Survival) trial. METHODS PMI was classified as a myocardial infarction occurring within 48 h of the procedure according to definitions of the SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries), ISCHEMIA (International Study Of Comparative Health Effectiveness With Medical And Invasive Approaches), and EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trials; the Fourth Universal Definition of MI; and the Society for Cardiovascular Angiography and Interventions (SCAI). Of the 1,800 patients enrolled, 1,652 with creatine kinase and/or creatine kinase-myocardial band (CK-MB) post-procedure were included. The association between PMI and mortality was analyzed by Cox regression. RESULTS PMI rates according to the SYNTAX and Fourth Universal Definition of MI, both of which required CK-MB elevation and electrocardiographic evidence of permanent myocardial damage, were 2.7% and 3.0%, respectively, in the PCI arm versus 2.4% and 2.1%, respectively, in the CABG arm. PMI rates according to the SCAI or EXCEL definition were higher in the PCI (5.7%) and CABG (16.5%) arms. PMIs according to the SYNTAX and Fourth Universal Definition of MI were more strongly associated with mortality than EXCEL and SCAI PMIs defined by isolated enzyme elevation when CK-MB was more than 10 times ULN. The impact of these "enzyme-driven events" on time-to-event curves and the composite endpoints was greater in the surgical cohort. PMIs after PCI were associated with 10-year mortality regardless of definition, whereas their impact on mortality after CABG was limited to 1 year. CONCLUSIONS The rates of PMI are highly dependent on their definition, which affects time-to-event curves, composite endpoints, and their lethal prognostic relevance. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050; SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).

中文翻译：

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围手术期心肌梗死对血运重建后结局的影响

背景 对于经皮冠状动脉介入治疗 (PCI) 和冠状动脉旁路移植术 (CABG) 手术后的围手术期心肌梗死 (PMI) 存在多种定义。目的 本研究的目的是根据各种定义调查 PMI 发生率、它们与 10 年全因死亡率的临床相关关联，以及它们对 SYNTAXES（PCI 与红豆杉和心脏的协同作用）中 5 年复合终点的影响。手术延长生存期）试验。方法 根据 SYNTAX（用于治疗狭窄动脉的 TAXUS 药物洗脱支架与冠状动脉搭桥手术）、缺血（国际健康有效性比较研究与医学研究）的定义，将 PMI 归类为在手术后 48 小时内发生的心肌梗死。和侵入性方法），和 EXCEL（XIENCE 与冠状动脉搭桥手术对左主干血运重建有效性的评估）试验；MI的第四个通用定义；和心血管血管造影和干预协会 (SCAI)。在入组的 1,800 名患者中，包括 1,652 名术后出现肌酸激酶和/或肌酸激酶-心肌带 (CK-MB) 的患者。通过 Cox 回归分析 PMI 与死亡率之间的关联。结果 根据 SYNTAX 和第四通用 MI 定义（两者都需要 CK-MB 升高和永久性心肌损伤的心电图证据），PCI 组的 PMI 率分别为 2.7% 和 3.0%，而分别为 2.4% 和 2.1%，分别在 CABG 臂中。根据 SCAI 或 EXCEL 定义的 PMI 率在 PCI (5.7%) 和 CABG (16.5%) 组中更高。当 CK-MB 超过 10 倍 ULN 时，根据 SYNTAX 和 MI 的第四通用定义的 PMI 与死亡率的相关性比由孤立酶升高定义的 EXCEL 和 SCAI PMI 更强。这些“酶驱动事件”对时间-事件曲线和复合终点的影响在手术队列中更大。无论定义如何，PCI 后 PMI 均与 10 年死亡率相关，而它们对 CABG 后死亡率的影响仅限于 1 年。结论 PMI 的发生率高度依赖于它们的定义，这会影响时间到事件曲线、复合终点及其致命的预后相关性。（PCI 与 TAXUS 和心脏手术之间的协同作用：SYNTAX 延长生存期 [SYNTAXES]；NCT03417050；SYNTAX 研究：TAXUS 药物洗脱支架与冠状动脉搭桥手术治疗狭窄的动脉 [SYNTAX]；NCT00114972）。