慢性完全闭塞病变对急性ST段抬高心肌梗死患者直接经皮介入治疗预后的影响

Impact of Chronic Rotal Occlusion in Patients with Acute ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention

目的:ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者中合并慢性完全闭塞(chronic total occlusion,CTO)可能与较差预后有关,但是仍然有争议。探讨慢性完全闭塞病变对急性ST段抬高心肌梗死患者直接经皮介入治疗预后的影响。方法:前瞻性入选从2014年1月至2018年1月在我中心接受介入治疗的313名STEMI患者。记录基线特征、病史、实验室检查、超声心动图和和并发症等资料。通过cox回归分析合并CTO病变对STEMI患者预后不良相关因素。结果:本研究共纳入313例患者。55例合并有CTO病变的患者,组成CTO组,其余为非CTO组。合并CTO的患者1年死亡率和MACE事件分别为9.1%和16.4%。CTO患者随访期间的主要心脏不良事件显著增加(HR=2.76;95%CI,1.73-4.81;P<0.05)。多变量分析显示CTO和MACE之间存在显著相关性(HR=2.23,95%CI 1.19-3.71,P<0.05)。结论:合并CTO病变的STEMI患者行急诊PCI风险较高,CTO病变是该人群MACE事件和死亡率的独立预测因子。

Objective:To explore whether a chronic total occlusion(CTO)in a non-infarct-related artery might be associated with a worse prognosis in long term benefit for ST-segment elevation myocardial infarction(STEIMI)patients.But it is still remain controversial.Methods:313 STEMI patients underwent percutaneous intervention(PCI)from Jan2014 to Jan 2018 in our center were enrolled in this prospective study. Baseline characteristics,medical history,biochemical findings,echocardiographic parameters,and complications were recorded. Factors related to worse outcome CTO in STEMI patients was analyzed by the cox logistic regression analysis for the hazard rate(HR).Results:A total of 383 patients were enrolled in this study. 55 cases which formed the CTO group had CTO in at least 1 coronary artery. 1-year mortality and MACE rate among patients with CTO were 9.1% and 16.4%. Major adverse cardiac events(MACE)during follow-up was significantly higher among patients with CTO(HR=2.76;95%CI,1.73-4.81;P<0.05). The multivariate analysis performed showed a significant association between CTO and MACE(HR=2.23,95%CI 1.19-3.71,P<0.05).Conclusion:Chronic total occlusion in this clinical setting identified patients at higher risk with more comorbidities and higher mortality,and behaved as an independent predictor of MACE.