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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 diagnostic criteria of PCI-related myocardial infarction after elective PCI (the consensus of the American College of Cardiology (JACC) in 2012 and the consensus of the 2013 Association of Cardiovascular Angiography and Intervention (SCAI) The feasibility of choosing more in line with the clinical diagnosis of PCI-related myocardial infarction standards. Methods A total of 510 hospitalized patients undergoing PCI at the Department of Cardiology of 306 Hospital of People’s Liberation Army from August 2011 to November 2014 were selected as the research objects and were divided into groups according to the diagnostic criteria of PCI-related myocardial infarction (JACC) in 2012 and SCAI consensus of 2013 The levels of cTn I, creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) in peripheral venous blood were measured within 48 hours after operation. Results According to the JACC criteria and SCAI criteria, the incidence of PCI-related myocardial infarction was 7.1% (36/510) and 3.3% (17/510), respectively. In addition to cTn I, CK and CK-MB were also significantly higher in SCAI than in JACC (P <0.05). Eight patients with PCI-related myocardial infarction who met the criteria of SCAI but did not meet the JACC criteria had significantly higher cTn I, CK and CK-MB levels than the 27 patients who met the JACC criteria but did not meet the SCAI criteria for elevation of troponin (P < 0.05). Conclusion SCAI expert consensus 2013 definition of PCI-related myocardial infarction clinically operable, more in line with clinical practice.