| Background:Percutaneous coronary intervention has become the main treatment for coronary atherosclerotic heart disease. With the development of techniques, more complex and multi-branches lesions are treated with percutaneous coronary interventions (PCIs). After percutaneous coronary interventions (PCIs), PCI related occurred in approximately 30% of the patents. Due to the anatomy and operation methods of Coronary Bifurcation Lesions, the risk of myocardial injury rises in these patients. So far, circulating myocardial injury biomarkers can be tested to determine whether myocardial injury occurs and the level of elevation can measure the area of injury and predict the prognosis for these patients.Objective:This research aimed at exploring the value of miR-133a in diagnosis of myocardial injury after PCI by testing the amount of circulating miR-133a, and comparing with troponin and heart type fatty acid binding protein.Methods:1.This study collected a cohort of consecutive patients underwent percutaneous coronary infarction at Changhai Hospital from January 2014 to December 2014, and the coronary bifurcation lesions were the research group. Patients underwent elective side branch vascular stenting before main vascular stenting and those without bifurcation lesions were excluded. All patients were divided into observation group and control group. Observation group involved patients with side branch damage group after PCI and was further divided into two subgroups, side branch vascular injury group and peripheral vascular damage group. The control group involved patients with bifurcation lesions and treated with PCI with no PCI related myocardial injury.2. We analyzed the basic clinical data and operation condition of the 2 groups.3. (1) Compare the levels of miRNAs, postoperative troponin, and heart type fatty acid binding protein in the 2 groups. (2) Compare the levels of miRNAs, postoperative troponin, and heart type fatty acid binding protein in the 2 subgroups.4. (1) We analyzed the correlation of the positive rates of miRNAs, postoperative troponin, and heart type fatty acid binding protein in all patients. (2) We analyzed the correlation of the positive rates of miRNAs, postoperative troponin, and heart type fatty acid binding protein in the observation group. (3) We analyzed the correlation of the positive rates of miRNAs and the diagnostic gold standard, coronary arteriography, in side branch damage group. (4) We analyzed the correlation of the positive rates of miRNAs and postoperative troponin in the peripheral vascular damage group.5. We assessed the diagnostic value of miR-133a for PCI related myocardial injury, side branch damage and peripheral vascular damage by area under the ROC curve and compared with postoperative troponin and heart type fatty acid binding protein.6.The MACEs in these patients in 3-12months after PCI were followed up, including cardiac death, nonfatal myocardial infarction, angina pectoris, revascularization, etc.Results:1. A total of 225 patients were included in the study.128 patients were included in the observation group, including 26 side branch damages and 102 peripheral vascular damages.2. There was no significant difference in the basic clinical data and operation condition between the 2 groups and 2 subgroups.3. (1) The levels of miRNAs, postoperative troponin, and heart type fatty acid binding protein elevated significantly in the observation group compared to the control group (P<0.001). (2) The levels of miRNAs, postoperative troponin, and heart type fatty acid binding protein elevated significantly in the 2 subgroups compared to the control group.4. (1) MiR-133a is positively correlated to troponin and heart type fatty acid binding protein in all patients (P<0.001). (2) MiR-133a is positively correlated to troponin and heart type fatty acid binding protein in observation group (P<0.001, P<0.05). (3) MiR-133a is positively correlated to diagnostic gold standard, coronary arteriography, in side branch damage group (P<0.001). (4) miR-133a is positively correlated to troponin in the peripheral vascular damage group (P<0.05).5. (1) The receiver operating characteristic curve analysis of miR-133a for bifurcation lesions PCI related injury revealed an area under the curve of 0.860 (95%CI: 0.810-0.910), with the diagnostic value a little lower than troponin, the AUC of which was 0.993 (95%CI:0-1) without significant difference (P>0.05). The diagnostic value of miR-133a was a little higher than heart type fatty acid binding protein, the AUC of which was 0.594 (95%CI:0.521-0.668) without significant difference (P>0.05). (2) In the side branch damage group, the AUC of miR-133a, troponin and heart type fatty acid binding protein was 0.912 (95%CI:0.721-0.897),0.967 (95%CI:0.918-0.991) and 0.818 (95%CI:0.738-0.881), respectively and no significant difference was observed. (3) In the peripheral vascular damage group, the AUC of miR-133a, troponin and heart type fatty acid binding protein was 0.846 (95%CI:0.788-0.893),1.0 (95%CI:0.981-1.0) and 0.536 (95%CI:0.464-0.607). The differences between 2 groups were significant (P<0.001).6. No post-operation major adverse cardiovascular events occurred in side branch damage group and non-side branch damage group. In the follow-up of 3-12months,12 (5.33%) MACEs occurred in all patients, with 10 (7.81%) in observation group and 2 (19.23%) in control group. The incidence of the major adverse cardiovascular events was 19.23%(5/26) in side branch damage group and 4.90%(5/102) in peripheral vascular damage group. The incidence of MACEs was significantly higher in observation group than the control group (P<0.05). Elevated miRNA-133a was positively correlated with higher risk in MACEs (P<0.001).Conclusion:1. Circulation miR-133a is elevated in blood in bifurcation lesions patients’with myocardial injury after PCI. MiR-133a is elevated in both side branch vascular injury patients and peripheral vascular damage patients. MiR-133a can be a biomarker to suggest PCI related myocardial injury.2. miR-133a is positively related to diagnostic gold standard, troponin, suggesting the diagnostic value miR-133a for PCI related myocardial injury.3. The diagnostic value of miR-133a is not lower than troponin on PCI related myocardial injury. The diagnostic value of miR-133a is similar with troponin and heart type fatty acid binding protein on side branch injury. The diagnostic value of miR-133a is and higher than heart type fatty acid binding protein but lower than troponin on peripheral vascular damage.4. PCI related myocardial injury patients have a higher risk of MACEs. The level of elevated MiR-133a is positively related to the incidence of MACEs, suggesting that miR-133a has a prognosis value for PCI related myocardial injury patients. |
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