Rott D, Behar S, Hod H, Feinberg M S, Boyko V, Mandelzweig L, Kaplinsky E, Gottlieb S
Heiden Department of Cardiology, Bikur Cholim Hospital, Jerusalem, Israel.
Am Heart J. 2001 Feb;141(2):267-76. doi: 10.1067/mhj.2001.111545.
Acute myocardial infarction (AMI) associated with significant left ventricular dysfunction (LVD) indicates a poor prognosis. Previous studies suggested that revascularization improves survival of patients with AMI complicated by cardiogenic shock. However, other studies that suggested that revascularization improves survival of stable patients with significant LVD did not specifically address patients who had recently had an AMI.
Our purpose was to determine whether patients with thrombolysis-treated AMI associated with significant LVD are likely to incur a survival advantage from catheterization and coronary revascularization performed within 30 days after AMI.
The study population was drawn from the Argatroban in Acute Myocardial Infarction-2 (ARGAMI-2) trial, which included 1200 patients with AMI, all of whom received thrombolytic therapy. Our analysis included 737 patients for whom LV function was estimated by echocardiography. Two hundred two patients had significant LVD; of them, 117 (58%) underwent cardiac catheterization and 85 were treated noninvasively. Among 535 patients without significant LVD, 291 (54%) underwent cardiac catheterization and 244 were treated noninvasively.
Compared with a noninvasive approach, an invasive approach resulted in reduced 30-day and 6-month mortality rates in patients with significant LVD: 4.3% versus 10.6%, adjusted odds ratio (OR) 0.26, 95% confidence interval (CI) 0.04 to 1.18, and 6.1% versus 15.5%, OR 0.27, 95% CI 0.06 to 0.98, respectively. A similar comparison in patients without significant LVD resulted in comparable 30-day and 6-month mortality rates for both patient groups: invasively versus noninvasively treated, 0.7% versus 0.8%, OR 1.04, 95% CI 0.04 to 12.7, and 1.4% versus 1.7%, adjusted OR 1.60, 95% CI 0.20 to 9.87.
The current study suggests that AMI patients with significant LVD may benefit from cardiac catheterization and revascularization performed early after AMI, whereas in patients without significant LVD the outcome of those treated invasively or conservatively was similar.
急性心肌梗死（AMI）合并严重左心室功能不全（LVD）提示预后不良。既往研究表明，血运重建可改善合并心源性休克的AMI患者的生存率。然而，其他提示血运重建可改善合并严重LVD的稳定患者生存率的研究并未专门针对近期发生AMI的患者。
我们的目的是确定溶栓治疗的合并严重LVD的AMI患者在AMI后30天内进行导管插入术和冠状动脉血运重建是否可能获得生存优势。
研究人群来自急性心肌梗死-2中的阿加曲班（ARGAMI-2）试验，该试验纳入了1200例AMI患者，所有患者均接受了溶栓治疗。我们的分析包括737例通过超声心动图评估左心室功能的患者。202例患者有严重LVD；其中，117例（58%）接受了心导管检查，85例接受了非侵入性治疗。在535例无严重LVD的患者中，291例（54%）接受了心导管检查，244例接受了非侵入性治疗。
与非侵入性方法相比，侵入性方法可降低有严重LVD患者的30天和6个月死亡率：分别为4.3%对10.6%，调整后的优势比（OR）为0.26，95%置信区间（CI）为0.04至1.18，以及6.1%对15.5%，OR为0.27，95%CI为0.06至0.98。对无严重LVD患者进行的类似比较显示，两组患者的30天和6个月死亡率相当：侵入性治疗与非侵入性治疗相比，分别为0.7%对0.8%，OR为1.04，95%CI为0.04至12.7，以及1.4%对1.7%，调整后的OR为1.60，95%CI为0.20至9.87。
当前研究表明，合并严重LVD的AMI患者可能从AMI后早期进行的心导管检查和血运重建中获益，而在无严重LVD的患者中，侵入性治疗或保守治疗的结果相似。
