ST段抬高型心肌梗死患者中梗死相关动脉合并心肌桥的发生率及其对经皮冠状动脉介入治疗的影响

Frequency of infarct-related artery with myocardial bridging in patients with ST-elevation myocardial infarction and its impact upon percutaneous coronary intervention.

作者信息

Yan Hong-bing, Wang Jian, Zhu Xiao-ling, Gao Hai, Li Nan, Ai Hui

机构信息

Emergency Center for Heart, Lung and Blood Vessel Diseases, Anzhen Hospital, Capital University of Medical Sciences, Beijing 100029, China.

出版信息

Chin Med J (Engl). 2006 Apr 5;119(7):539-43.

PMID:16620693

Abstract

BACKGROUND

Myocardial bridging (MB) as a congenital condition with a reported frequency of 5% - 12% in diagnostic coronary angiography may be an important factor causing myocardial ischemia. However, its frequency in the infarct-related artery (IRA) of patients with ST-elevation myocardial infarction (STEMI) and the impact upon percutaneous coronary intervention (PCI) remain undetermined. In this study, we investigated MB frequency and its impact upon primary PCI in patients with STEMI.

METHODS

The data of coronary angiography for 554 consecutive patients with STEMI who had undergone successful primary PCI were retrospectively analyzed to identify a frequency of MB in the IRA and its association with gender and age. According to the angiographic findings, the patients were divided into MB patients and non-MB patients. The endpoints of this study included immediate angiographic findings after primary PCI and 6-month major adverse cardiac events (MACE) (death, recurrent myocardial infarction, target lesion or vessel revascularization) between the MB patients and the non-MB patients.

RESULTS

A frequency of MB in the IRA of 46 patients (8.3%) was identified in this series; it was more common in patients > or = 65 years old (36/206) than in those < 65 years old (10/348) (17.5% vs 2.9%, P < 0.001). The trend of MB in the IRA was observed more frequently in women without significant difference than in men (10.2% vs 7.8%). TIMI grade III flow was achieved in 91.9% (509/554) of all patients following primary PCI, in 60.9% (28/46) of the MB patients and in 94.7% (481/508) of the non-MB patients respectively (P < 0.001). The in-hospital mortality was 4.7% (26/554) in this series including 13.0% (6/46) of the MB patients and 3.9% (20/508) of the non-MB patients (P < 0.001). A significant difference in 6 months MACE was seen between the MB patients (19%) and the non-MB patients (6.2%) (P < 0.001).

CONCLUSIONS

MB in the IRA is relatively common in elderly patients with STEMI with a more evident trend in women, suggesting that arteriosclerosis and plaque rupture occurs more easily in the proximal artery to MB than in younger patients. Poor TIMI grade flow in patients with MB in the IRA after primary PCI may contribute to a high in-hospital mortality rate (13%) and 6-month MACE (19%) in the MB patients.

摘要

背景

心肌桥（MB）作为一种先天性疾病，在诊断性冠状动脉造影中的发生率为5% - 12%，可能是导致心肌缺血的重要因素。然而，其在ST段抬高型心肌梗死（STEMI）患者梗死相关动脉（IRA）中的发生率以及对经皮冠状动脉介入治疗（PCI）的影响仍未明确。在本研究中，我们调查了STEMI患者中MB的发生率及其对直接PCI的影响。

方法

回顾性分析554例成功接受直接PCI的STEMI患者的冠状动脉造影数据，以确定IRA中MB的发生率及其与性别和年龄的关系。根据血管造影结果，将患者分为MB患者和非MB患者。本研究的终点包括直接PCI后的即时血管造影结果以及MB患者和非MB患者之间的6个月主要不良心脏事件（MACE）（死亡、再发心肌梗死、靶病变或血管再血管化）。

结果

本系列中46例患者（8.3%）的IRA中发现有MB；在年龄≥65岁的患者中（36/206）比<65岁的患者中（10/348）更常见（17.5%对2.9%，P<0.001）。IRA中MB的趋势在女性中比男性中观察到更频繁，但无显著差异（10.2%对7.8%）。所有患者在直接PCI后91.9%（509/554）达到TIMI 3级血流，MB患者中为60.9%（28/46），非MB患者中为94.7%（481/508）（P<0.001）。本系列住院死亡率为4.7%（26/554），其中MB患者为13.0%（6/46），非MB患者为3.9%（20/508）（P<0.001）。MB患者（19%）和非MB患者（6.2%）之间6个月MACE有显著差异（P<0.001）。