左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响

doi:10.3969/j.issn.1006-7795.2022.02.024

摘要/Abstract

摘要： 目的探讨左心室收缩功能对经皮冠状动脉介入(percutaneous coronary intervention, PCI)治疗的急性下壁ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者预后的影响。方法对161例PCI治疗的急性下壁STEMI患者按左心室收缩功能分为2组:左心室收缩功能障碍[左心室射血分数(left ventricular ejection fraction, LVEF)<50%]组和左心室收缩功能正常(LVEF≥50%)组。本研究的主要终点主要不良心脏事件(major adverse cardiac events, MACE)包括所有全因死亡、再发性心肌梗死、缺血驱动的血管血运重建和卒中。结果两组患者在年龄、性别、病史、Killip分级以及症状发作时间方面比较,差异均无统计学意义(P>0.05);左心室收缩功能障碍组具有更高的病变血管支数和血栓负荷(P<0.05),其他冠状动脉造影结果和介入治疗特征,两组间差异均无统计学意义(P>0.05)。两组在1年预期MACE发生率方面比较,差异均无统计学意义(Log-rank P>0.05)。结论在接受直接PCI治疗的急性下壁STEMI患者中,左心室收缩功能障碍的患者与左心室收缩功能正常的患者具有相似的1年临床不良事件发生率。

关键词: 左心室射血分数, 急性ST段抬高型心肌梗死, 经皮冠状动脉介入治疗

Abstract: Objective To study the impact of left ventricular (LV) systolic function on outcomes of patients with acute inferior ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods Left ventricular ejection fraction (LVEF) was determined in 161 acute inferior STEMI patients undergoing PCI, who were divided into two groups according to LV systolic function: (1) LV systolic dysfunction group (LVEF<50%); (2) normal LV systolic function group (LVEF≥50%). Study primary endpoints included major adverse cardiac events (MACE) defined as the composite of cardiac death, myocardial infarction, and ischemia-driven revascularization, and stroke. Results There was no significant difference in age, gender, medical history, Killip grade and time of symptom onset between the two groups (P>0.05). The average number of disease vessels and thrombus burden were higher in LV systolic dysfunction group (P<0.05), other baseline angiographic and procedural characteristics in this study were similar between the two groups (P>0.05). During the 1-year follow-up, the incidence of MACE was similar between the two groups in this study (Log-rank P>0.05). Conclusion Among patients with acute inferior STEMI undergoing PCI, the incidence of clinical adverse events in patients with LV systolic dysfunction was similar to that in patients with normal LV systolic function during 1-year follow-up.

Key words: left ventricular ejection fraction, acute ST-segment elevation myocardial infarction, percutaneous coronary intervention

中图分类号:

R542.2⁺2

孙昊, 郑美丽, 郭宗生, 张智勇, 李晓涛. 左心室收缩功能对经皮冠状动脉介入治疗的急性下壁ST段抬高型心肌梗死患者预后的影响[J]. 首都医科大学学报, 2022, 43(2): 305-310.

Sun Hao, Zheng Meili, Guo Zongsheng, Zhang Zhiyong, Li Xiaotao. The prognostic importance of left ventricular systolic function in patients with acute inferior ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention[J]. Journal of Capital Medical University, 2022, 43(2): 305-310.

参考文献

[1] Marenzi G, Moltrasio M, Assanelli E, et al. Impact of cardiac and renal dysfunction on inhospital morbidity and mortality of patients with acute myocardial infarction undergoing primary angioplasty[J]. Am Heart J, 2007, 153(5): 755-762.
[2] Van der Vleuten P A, Rasoul S, Huurnink W, et al. The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention[J]. BMC Cardiovasc Disord, 2008, 8: 4.
[3] Zijlstra F, Hoorntje J C, De Boer M J, et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction[J]. N Engl J Med, 1999, 341(19): 1413-1419.
[4] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J]. 中华心血管病杂志, 2019, 47(10): 766-783.
[5] 中华医学会心血管病学分会介入心脏病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会, 中华心血管病杂志编辑委员会, 等. 中国经皮冠状动脉介入治疗指南(2016)[J]. 中华心血管病杂志, 2016, 44(5): 382-400.
[6] Cutlip D E, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions[J]. Circulation, 2007, 115(17): 2344-2351.
[7] Kim S S, Choi H S, Jeong M H, et al. Clinical outcomes of acute myocardial infarction with occluded left circumflex artery[J]. J Cardiol, 2011, 57(3): 290-296.
[8] Chen Z W, Yu Z Q, Yang H B, et al. Rapid predictors for the occurrence of reduced left ventricular ejection fraction between LAD and non-LAD related ST-elevation myocardial infarction[J]. BMC Cardiovasc Disord, 2016, 16: 3.
[9] Addala S, Grines C L, Dixon S R, et al. Predicting mortality in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PAMI risk score)[J]. Am J Cardiol, 2004, 93(5): 629-632.
[10] Halkin A, Singh M, Nikolsky E, et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: the Cadillac risk score[J]. J Am Coll Cardiol, 2005, 45(9): 1397-1405.
[11] Entezarjou A, Mohammad M A, Andell P, et al. Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction[J]. Open Heart, 2018, 5(2): e000852.
[12] Gupta T, Weinreich M, Kolte D, et al. Comparison of incidence and outcomes of cardiogenic shock complicating posterior (inferior) versus anterior ST-elevation myocardial infarction[J]. Am J Cardiol, 2020, 125(7): 1013-1019.
[13] Noguchi M, Sakakura K, Akashi N, et al. The comparison of clinical outcomes between inferior ST-elevation myocardial infarction with right ventricular infarction versus without right ventricular infarction[J]. Int Heart J, 2019, 60(3): 560-568.
[14] Welty F K, Mittleman M A, Lewis S M, et al. Significance of location (anterior versus inferior) and type (Q-wave versus non-Q-wave) of acute myocardial infarction in patients undergoing percutaneous transluminal coronary angioplasty for postinfarction ischemia[J]. Am J Cardiol, 1995, 76(7): 431-435.
[15] Gomez J F, Zareba W, Moss A J, et al. Prognostic value of location and type of myocardial infarction in the setting of advanced left ventricular dysfunction[J]. Am J Cardiol, 2007, 99(5): 642-646.
[16] Wita K, Filipecki A, Szydło K, et al. Prediction of long-term outcome after primary percutaneous coronary intervention for acute anterior myocardial infarction[J]. Kardiol Pol, 2010, 68(4): 393-400.
[17] Huang X, Redfors B, Chen S, et al. Predictors of mortality in patients with non-anterior ST-segment elevation myocardial infarction: analysis from the HORIZONS-AMI trial[J]. Catheter Cardiovasc Interv, 2019, 94(2): 172-180.
[18] Loh E, Sutton M S, Wun C C, et al. Ventricular dysfunction and the risk of stroke after myocardial infarction[J]. N Engl J Med, 1997, 336(4): 251-257.
[19] Lamas G A, Vaughan D E, Pfeffer M A. Left ventricular thrombus formation after first anterior wall acute myocardial infarction[J]. Am J Cardiol, 1988, 62(1): 31-35.
[20] Guagliumi G, Stone G W, Cox D A, et al. Outcome in elderly patients undergoing primary coronary intervention for acute myocardial infarction: results from the controlled abciximab and device investigation to lower late angioplasty complications (Cadillac) trial[J]. Circulation, 2004, 110(12): 1598-1604.