Katayama Naoyuki, Horiuchi Kenji, Nakao Koichi, Kasanuki Hiroshi, Honda Takashi
Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto.
J Cardiol. 2005 Jul;46(1):1-8.
To evaluate whether percutaneous coronary intervention (PCI)in non-culprit vessel lesions improves the short-term prognosis of acute myocardial infarction complicated by pump failure.
Fifty-six patients with acute myocardial infarction in hemodynamic subset 4 of Forrester's classification at hospitalization underwent PCI for multiple vessel lesions within 12 hr (6.1 +/- 3.4 hr) of the onset of acute myocardial infarction. No patients had left main trunk lesion. Twenty patients also underwent PCI for non-culprit vessel lesions (multivessel PCI group: M-PCI), but the remaining 36 did not (culprit vessel PCI group: C-PCI). The in-hospital prognosis was investigated from the hospital records.
Complete revascularization was accomplished in 18 patients(90%)in the M-PCI. The rates of all in-hospital death were almost equivalent in both groups (M-PCI 30% vs C-PCI 42%, p = 0.21), but the rate of cardiac deaths was higher in the C-PCI than in the M-PCI (42% vs 15%, p < 0.05). Overall major adverse cardiac events occurred more often in the C-PCI than in the M-PCI(58% vs 25%, p < 0.05). Multivariate logistic regression analysis showed complete revascularization(odds ratio 0.11, 95% confidence interval 0.02-0.95, p < 0.05)and duration from onset of acute myocardial infarction to PCI < 6 hr (odds ratio 0.25, 95% confidence interval 0.06-0.98, p < 0.05) were negative predictors of in-hospital cardiac death, and prior myocardial infarction (odds ratio 4.97, 95% confidence interval 1.09-22.67, p < 0.05) was a positive predictor.
PCI of non-culprit vessel lesions might improve the short-term prognosis of patients with acute myocardial infarction and pump failure.
评估对非罪犯血管病变进行经皮冠状动脉介入治疗（PCI）是否能改善并发泵衰竭的急性心肌梗死患者的短期预后。
56例住院时处于Forrester分类血流动力学亚组4的急性心肌梗死患者在急性心肌梗死发病后12小时内（6.1±3.4小时）对多支血管病变进行了PCI。无患者有左主干病变。20例患者还对非罪犯血管病变进行了PCI（多支血管PCI组：M-PCI），但其余36例未进行（罪犯血管PCI组：C-PCI）。从医院记录中调查住院期间的预后情况。
M-PCI组18例患者（90%）实现了完全血运重建。两组的院内总死亡率几乎相当（M-PCI组30% vs C-PCI组42%，p = 0.21），但C-PCI组的心脏死亡率高于M-PCI组（42% vs 15%，p < 0.05）。总体主要不良心脏事件在C-PCI组比M-PCI组更常发生（58% vs 25%，p < 0.05）。多因素逻辑回归分析显示，完全血运重建（比值比0.11，95%置信区间0.02 - 0.95，p < 0.05）以及急性心肌梗死发病至PCI的时间<6小时（比值比0.25，95%置信区间0.06 - 0.98，p < 0.05）是院内心脏死亡的负性预测因素，而既往心肌梗死（比值比4.97，95%置信区间1.09 - 22.67，p < 0.05）是正性预测因素。
对非罪犯血管病变进行PCI可能改善急性心肌梗死并发泵衰竭患者的短期预后。
