冠状动脉左主干(LMCA)完全闭塞致急性心肌梗死(AMI) 25例临床分析

Clinical analysis of 25 patients with acute myocardial infarction(AMI) caused by left main coronary artery total occlusion(LMCA)

目的探讨冠状动脉左主干(left main coronary artery,LMCA)急性完全闭塞(100%)导致急性心肌梗死(acute myocardial infarction,AMI),患者的临床特点、治疗方法和近期死亡危险因素。方法回顾性分析2002年8月至2014年1月于我院因心肌梗死行急诊冠脉造影证实LMCA急性完全闭塞患者的住院资料,并按住院期间是否死亡分为死亡组和生存组,比较两组患者临床特点和治疗方法的差异性。电话随访生存组患者心血管事件发生情况。结果 2 214例急诊冠脉造影患者中LMCA急性完全闭塞25例(1.13%),其中入院时出现心源性休克13例(52%),严重室性心律失常8例(32%),成功施行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)19例(76%),住院期间死亡8例(32%)。住院死亡组患者的心源性休克(100%)、急性肺水肿(100%)、严重室性心律失常(63%)、术中心肺复苏(50%)、术后心功能衰竭(50%)的发生率均显著高于生存组,死亡组患者入院时血压(81/50 mmHg)显著低于生存组。心源性休克是住院死亡的独立危险因素(OR=17.32)。结论 LMCA急性完全闭塞患者死亡率极高,入院时心源性休克、术中心肺复苏、术后心功能衰竭提示预后不良。成功的PCI可能可以挽救部分患者生命。

Objective To explore the clinical characteristics of the patients with acute myocardial infarction （AMI） due to left main coronary artery （LMCA） total occlusion, and to find out treatment method and predictive factors. Methods The retrospective analysis was performed on the patients with LMCA total occlusion who were proved by emergency coronary angiography in our hospital from Aug. 2002 to Jan. 2014. Clinical outcomes and treatment methods were compared between death group and survival group. The telephone follow-up was made in all survival cases. Results Of 2 214 emergency coronary angiography cases, there were 25 patients （1. 13%） with LMCA total occlusion, including 13 cases （52%） with cardiogenie shock on admission, 18 cases （32 % ） with severe ventricular arrhythrnias, 19 cases （76 %） treated successfully by pereutaneous coronary intervention （PCI）, 8 cases （32%） died in hospital. The incidence of eardiogenic shock （ 100%）, acute pulmonary edema （100%）, severe ventricular arrhythmia （63%）, intraoperative cardiopulmonary resuscitation （50%）, and postoperative heart failure （50%） in death group were significantly higher than in survival group. Blood pressure on admission in death group was significantly lower than in survival group. Cardiogenic shock was independently predictive of in-hospital mortality （OR =17.32）. Conclusions The mortality of the patients with left main artery total occlusion was significantly high. Preoperative cardiogenic shock, intraoperative cardiopulmonary resuscitation, and postoperative heart failure were independent predictors of unfavourable prognosis. Successful PCI to these patients may be feasible and effective.