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Подъем маркеров некроза миокарда у больных с хронической ишемической болезнью сердца и артериальной гипертензией и однолетний прогноз - Журнал Системные Гипертензии Том 12, №1
Подъем маркеров некроза миокарда у больных с хронической ишемической болезнью сердца и артериальной гипертензией и однолетний прогноз
Миронова О.Ю. Подъем маркеров некроза миокарда у больных с хронической ишемической болезнью сердца и артериальной гипертензией и однолетний прогноз. Системные гипертензии. 2015; 1: 32–36.
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Аннотация
Цель исследования. Определить частоту инфаркта миокарда (ИМ) типа 4а и перипроцедурного повреждения миокарда у пациентов со стабильной ишемической болезнью сердца (ИБС) и артериальной гипертензией (АГ).
Материал и методы. Скринингу был подвергнут 281 человек с показаниями для проведения коронарной ангиографии (КАГ) с возможным чрескожным коронарным вмешательством (ЧКВ). В исследование были включены 183 человека со стабильной ИБС, у которых определялся уровень маркеров некроза миокарда после ангиопластики. Были сформированы по три группы больных в зависимости от степени повышения тропонина и МВ-КК – МВ-фракция креатинкиназы (1-я группа – показатель в норме; 2-я – от 1 до 3 верхних границ нормы − ВГН; 3-я – выше 3 ВГН). 167 пациентов страдали АГ. В случае повышения маркеров повторно проводились эхокардиография и магнитно-резонансная томография (МРТ) сердца.
Результаты. Частота развития ИМ типа 4а в изучаемой группе пациентов с хронической ИБС и АГ составила 10,8%.Частота развития повреждения миокарда после ЧКВ составила 16,2%. В результате дискриминантного анализа была получена прогностическая модель, позволяющая судить о вероятности развития перипроцедурного повреждения миокарда: 0,871 × пол (мужской = 0, женский = 1) + 0,516 × функциональный класс (ФК) стенокардии + 0,022 × возраст (годы) - 0,011 × скорость клубочковой фильтрации (СКФ) + 0,27 × количество пораженных сосудов ≥2,731.
Заключение. К группе пациентов высокого риска развития перипроцедурного повреждения миокарда относятся пожилые женщины со сниженной СКФ и многососудистым поражением коронарных артерий, страдающие стенокардией 3–4 ФК. Эти больные требуют более тщательной подготовки к ангиопластике и выбору оптимальной терапии. Особой осторожности требуют вмешательства на огибающей артерии.
Ключевые слова: тропонин, МВ-креатинкиназа, перипроцедурный инфаркта миокарда, инфаркт миокарда типа 4а, инфаркт миокарда после чрескожного коронарного вмешательства, артериальная гипертензия, чрескожные коронарные вмешательства, однолетний прогноз.
Material and methods. 281 patients were screened before the enrollment in our study. 183 patients with stable CAD were included in our study whose levels of cardiac troponin I and CK-MB (creatine kinase-MB fraction) were studied after PCI. We divided patients into the groups according to their levels of cardiac troponin I after PCI and CK-MB (group 1 − no elevation; 2 − elevation 1−3 upper limits of normal − ULN; III − more than 3 ULN).167 patients had AH. In case of detected rise of CK-MB and/or troponin echocardiography and cardiac magnetic resonance imaging (MRI) were performed.
Results. The prevalence of MI type 4a was 10,8% and periprocedural myocardial damage – 16,2% respectively. After performing the discriminant analysis we sought to build a prognostic model and calculate the formula of periprocedural myocardial damage probability: 0,871 × gender (male = 0; female = 1)+0,516 × angina pectoris functional class + 0,022 × age (years) - 0,011 × (estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease – MDRD formula) + 0,27 × number of diseased coronary arteries ≥2,731.
Conclusion. Women with low EGFR (MDRD), mutivessel disease and angina pectoris class 3−4 (NYHA) have the highest risk of MI type 4a. The most difficult localization for PCI is circumflex artery.
Key words: troponin, creatine kinase-MB, periprocedural myocardial infarction, myocardial infarction type 4a, myocardial infarction after percutaneous interventions, arterial hypertension, percutaneous interventions, 1-year prognosis.
Материал и методы. Скринингу был подвергнут 281 человек с показаниями для проведения коронарной ангиографии (КАГ) с возможным чрескожным коронарным вмешательством (ЧКВ). В исследование были включены 183 человека со стабильной ИБС, у которых определялся уровень маркеров некроза миокарда после ангиопластики. Были сформированы по три группы больных в зависимости от степени повышения тропонина и МВ-КК – МВ-фракция креатинкиназы (1-я группа – показатель в норме; 2-я – от 1 до 3 верхних границ нормы − ВГН; 3-я – выше 3 ВГН). 167 пациентов страдали АГ. В случае повышения маркеров повторно проводились эхокардиография и магнитно-резонансная томография (МРТ) сердца.
Результаты. Частота развития ИМ типа 4а в изучаемой группе пациентов с хронической ИБС и АГ составила 10,8%.Частота развития повреждения миокарда после ЧКВ составила 16,2%. В результате дискриминантного анализа была получена прогностическая модель, позволяющая судить о вероятности развития перипроцедурного повреждения миокарда: 0,871 × пол (мужской = 0, женский = 1) + 0,516 × функциональный класс (ФК) стенокардии + 0,022 × возраст (годы) - 0,011 × скорость клубочковой фильтрации (СКФ) + 0,27 × количество пораженных сосудов ≥2,731.
Заключение. К группе пациентов высокого риска развития перипроцедурного повреждения миокарда относятся пожилые женщины со сниженной СКФ и многососудистым поражением коронарных артерий, страдающие стенокардией 3–4 ФК. Эти больные требуют более тщательной подготовки к ангиопластике и выбору оптимальной терапии. Особой осторожности требуют вмешательства на огибающей артерии.
Ключевые слова: тропонин, МВ-креатинкиназа, перипроцедурный инфаркта миокарда, инфаркт миокарда типа 4а, инфаркт миокарда после чрескожного коронарного вмешательства, артериальная гипертензия, чрескожные коронарные вмешательства, однолетний прогноз.
________________________________________________
Material and methods. 281 patients were screened before the enrollment in our study. 183 patients with stable CAD were included in our study whose levels of cardiac troponin I and CK-MB (creatine kinase-MB fraction) were studied after PCI. We divided patients into the groups according to their levels of cardiac troponin I after PCI and CK-MB (group 1 − no elevation; 2 − elevation 1−3 upper limits of normal − ULN; III − more than 3 ULN).167 patients had AH. In case of detected rise of CK-MB and/or troponin echocardiography and cardiac magnetic resonance imaging (MRI) were performed.
Results. The prevalence of MI type 4a was 10,8% and periprocedural myocardial damage – 16,2% respectively. After performing the discriminant analysis we sought to build a prognostic model and calculate the formula of periprocedural myocardial damage probability: 0,871 × gender (male = 0; female = 1)+0,516 × angina pectoris functional class + 0,022 × age (years) - 0,011 × (estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease – MDRD formula) + 0,27 × number of diseased coronary arteries ≥2,731.
Conclusion. Women with low EGFR (MDRD), mutivessel disease and angina pectoris class 3−4 (NYHA) have the highest risk of MI type 4a. The most difficult localization for PCI is circumflex artery.
Key words: troponin, creatine kinase-MB, periprocedural myocardial infarction, myocardial infarction type 4a, myocardial infarction after percutaneous interventions, arterial hypertension, percutaneous interventions, 1-year prognosis.
Полный текст
Список литературы
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2. James PA, Oparil S, Carter BL et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (5): 507–20.
3. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289 (19): 2560–71.
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5. Heidenreich PA, Trogdon JG, Khavjou OA et al. On behalf of the American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011; 123: 933–44.
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8. Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J 2007; 28: 2525–38; Circulation 2007; 116: 2634–53; J Am Coll Cardiol 2007; 50: 2173–95.
9. Nallamothu BK, Chetcuti S, Mukherjee D et al. Prognostic implication of troponin I elevation after percutaneous coronary intervention. Am J Cardiol 2003; 91: 1272–74.
10. Fuchs S, Kornowski R, Mehran R et al. Prognostic value of cardiac troponin-I levels following catheter-based coronary interventions. Am J Cardiol 2000; 85: 1077–82.
11. Cavallini C, Savonitto S, Violini R et al. Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study. Eur Heart J 2005; 26: 1494–98.
12. Миронова О.Ю. Индуцированная контрастными веществами нефропатия. Терапевт. арх. 2013; 85 (6): 90–5. / Mironova O.Iu. Indutsirovannaia kontrastnymi veshchestvami nefropatiia. Terapevt. arkh. 2013; 85 (6): 90–5. [in Russian]
13. Kamugai S, Ishii H et al. Impact of chronic kidney disease on the incidence of peri-procedural myocardial injury in patients undergoing elective stent implantation. Nephrol Dial Transplant 2012; 27 (3): 1059–63.
14. Miyagi M, Ishii H et al. Impact of renal function on coronary plaque composition. Nephrol Dial Transplant 2010; 25 (1): 175–81.
15. 2013 ESH/ESC Guidelines for the management of arterial hypertension Eur Heart J 2013; 34: 2159–19.
16. Berger AK, Herzog CA. CABG in CKD: untangling the letters of risk Nephrol Dial Transplant 2010; 25 (11): 3477–9.
2. James PA, Oparil S, Carter BL et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (5): 507–20.
3. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289 (19): 2560–71.
4. Kearney PM, Whelton M, Reynolds K et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217–23.
5. Heidenreich PA, Trogdon JG, Khavjou OA et al. On behalf of the American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011; 123: 933–44.
6. Guo X, Zhang X, Guo L et al. Association between pre-hypertension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Curr Hypertens Rep 2013; 15: 703–16.
7. Murray CJ, Vos T, Lozano R et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 [published correction appears in Lancet 2013; 381: 628]. Lancet 2012; 380: 2197–223.
8. Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J 2007; 28: 2525–38; Circulation 2007; 116: 2634–53; J Am Coll Cardiol 2007; 50: 2173–95.
9. Nallamothu BK, Chetcuti S, Mukherjee D et al. Prognostic implication of troponin I elevation after percutaneous coronary intervention. Am J Cardiol 2003; 91: 1272–74.
10. Fuchs S, Kornowski R, Mehran R et al. Prognostic value of cardiac troponin-I levels following catheter-based coronary interventions. Am J Cardiol 2000; 85: 1077–82.
11. Cavallini C, Savonitto S, Violini R et al. Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study. Eur Heart J 2005; 26: 1494–98.
12. Mironova O.Iu. Indutsirovannaia kontrastnymi veshchestvami nefropatiia. Terapevt. arkh. 2013; 85 (6): 90–5. [in Russian]
13. Kamugai S, Ishii H et al. Impact of chronic kidney disease on the incidence of peri-procedural myocardial injury in patients undergoing elective stent implantation. Nephrol Dial Transplant 2012; 27 (3): 1059–63.
14. Miyagi M, Ishii H et al. Impact of renal function on coronary plaque composition. Nephrol Dial Transplant 2010; 25 (1): 175–81.
15. 2013 ESH/ESC Guidelines for the management of arterial hypertension Eur Heart J 2013; 34: 2159–19.
16. Berger AK, Herzog CA. CABG in CKD: untangling the letters of risk Nephrol Dial Transplant 2010; 25 (11): 3477–9.
2. James PA, Oparil S, Carter BL et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (5): 507–20.
3. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289 (19): 2560–71.
4. Kearney PM, Whelton M, Reynolds K et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217–23.
5. Heidenreich PA, Trogdon JG, Khavjou OA et al. On behalf of the American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011; 123: 933–44.
6. Guo X, Zhang X, Guo L et al. Association between pre-hypertension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Curr Hypertens Rep 2013; 15: 703–16.
7. Murray CJ, Vos T, Lozano R et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 [published correction appears in Lancet 2013; 381: 628]. Lancet 2012; 380: 2197–223.
8. Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J 2007; 28: 2525–38; Circulation 2007; 116: 2634–53; J Am Coll Cardiol 2007; 50: 2173–95.
9. Nallamothu BK, Chetcuti S, Mukherjee D et al. Prognostic implication of troponin I elevation after percutaneous coronary intervention. Am J Cardiol 2003; 91: 1272–74.
10. Fuchs S, Kornowski R, Mehran R et al. Prognostic value of cardiac troponin-I levels following catheter-based coronary interventions. Am J Cardiol 2000; 85: 1077–82.
11. Cavallini C, Savonitto S, Violini R et al. Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study. Eur Heart J 2005; 26: 1494–98.
12. Миронова О.Ю. Индуцированная контрастными веществами нефропатия. Терапевт. арх. 2013; 85 (6): 90–5. / Mironova O.Iu. Indutsirovannaia kontrastnymi veshchestvami nefropatiia. Terapevt. arkh. 2013; 85 (6): 90–5. [in Russian]
13. Kamugai S, Ishii H et al. Impact of chronic kidney disease on the incidence of peri-procedural myocardial injury in patients undergoing elective stent implantation. Nephrol Dial Transplant 2012; 27 (3): 1059–63.
14. Miyagi M, Ishii H et al. Impact of renal function on coronary plaque composition. Nephrol Dial Transplant 2010; 25 (1): 175–81.
15. 2013 ESH/ESC Guidelines for the management of arterial hypertension Eur Heart J 2013; 34: 2159–19.
16. Berger AK, Herzog CA. CABG in CKD: untangling the letters of risk Nephrol Dial Transplant 2010; 25 (11): 3477–9.
________________________________________________
2. James PA, Oparil S, Carter BL et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (5): 507–20.
3. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289 (19): 2560–71.
4. Kearney PM, Whelton M, Reynolds K et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217–23.
5. Heidenreich PA, Trogdon JG, Khavjou OA et al. On behalf of the American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011; 123: 933–44.
6. Guo X, Zhang X, Guo L et al. Association between pre-hypertension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Curr Hypertens Rep 2013; 15: 703–16.
7. Murray CJ, Vos T, Lozano R et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 [published correction appears in Lancet 2013; 381: 628]. Lancet 2012; 380: 2197–223.
8. Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal definition of myocardial infarction. Eur Heart J 2007; 28: 2525–38; Circulation 2007; 116: 2634–53; J Am Coll Cardiol 2007; 50: 2173–95.
9. Nallamothu BK, Chetcuti S, Mukherjee D et al. Prognostic implication of troponin I elevation after percutaneous coronary intervention. Am J Cardiol 2003; 91: 1272–74.
10. Fuchs S, Kornowski R, Mehran R et al. Prognostic value of cardiac troponin-I levels following catheter-based coronary interventions. Am J Cardiol 2000; 85: 1077–82.
11. Cavallini C, Savonitto S, Violini R et al. Impact of the elevation of biochemical markers of myocardial damage on long-term mortality after percutaneous coronary intervention: results of the CK-MB and PCI study. Eur Heart J 2005; 26: 1494–98.
12. Mironova O.Iu. Indutsirovannaia kontrastnymi veshchestvami nefropatiia. Terapevt. arkh. 2013; 85 (6): 90–5. [in Russian]
13. Kamugai S, Ishii H et al. Impact of chronic kidney disease on the incidence of peri-procedural myocardial injury in patients undergoing elective stent implantation. Nephrol Dial Transplant 2012; 27 (3): 1059–63.
14. Miyagi M, Ishii H et al. Impact of renal function on coronary plaque composition. Nephrol Dial Transplant 2010; 25 (1): 175–81.
15. 2013 ESH/ESC Guidelines for the management of arterial hypertension Eur Heart J 2013; 34: 2159–19.
16. Berger AK, Herzog CA. CABG in CKD: untangling the letters of risk Nephrol Dial Transplant 2010; 25 (11): 3477–9.
Авторы
О.Ю.Миронова
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, 15а
olgav39@gmail.com
A.L.Miasnikov Institute of Clinical Cardiology, Russian Cardiology Research And Production Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, 3d Cherepkovskaya st., 15а
olgav39@gmail.com
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, 15а
olgav39@gmail.com
________________________________________________
A.L.Miasnikov Institute of Clinical Cardiology, Russian Cardiology Research And Production Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, 3d Cherepkovskaya st., 15а
olgav39@gmail.com
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