Shiraishi Jun, Kohno Yoshio, Sawada Takahisa, Takeda Mitsuo, Arihara Masayasu, Hyogo Masayuki, Yagi Takakazu, Shima Takatomo, Okada Takashi, Nakamura Takeshi, Matoba Satoaki, Yamada Hiroyuki, Shirayama Takeshi, Kitamura Makoto, Furukawa Keizo, Matsubara Hiroaki
Department of Cardiology, Kyoto First Red Cross Hospital, and Department of Cardiology and Vascular Regenerative Medicine, Kyhoto Prefectural University School of Medicine, Kyoto, Japan.
Circ J. 2008 Aug;72(8):1225-9. doi: 10.1253/circj.72.1225.
Recurrent acute myocardial infarction (AMI) is a deteriorated condition with high in-hospital morbidity and mortality, but the predictors of in-hospital outcome after primary percutaneous coronary intervention (PCI) for repeat AMI remain unclear.
Using the AMI-Kyoto Multi-Center Risk Study database, clinical background, angiographic findings, results of primary PCI, and in-hospital prognosis were retrospectively compared between primary PCI-treated AMI patients with previous myocardial infarction (MI) (repeat-MI patients, n=235) and those without previous MI (first-MI patients, n=1,550). The repeat-MI patients had higher prevalence of Killip class>or=3 at admission, larger number of diseased vessels, and a significantly higher in-hospital mortality rate than the first-MI patients. On multivariate analysis, number of diseased vessels>or=2 or diseased left main trunk (LMT) on initial coronary angiography was the independent positive predictor of in-hospital mortality in the repeat-MI patients, not in the first-MI patients, whereas acquisition of Thrombolysis In Myocardial Infarction 3 flow in the infarct-related artery immediately after primary PCI and elapsed time<24 h were the negative predictors in the first-MI patients, not in the repeat-MI patients.
Number of diseased vessels>or=2 or diseased LMT on initial coronary angiography is an independent risk factor of in-hospital death in recurrent-AMI patients undergoing primary PCI.
复发性急性心肌梗死（AMI）是一种病情恶化、院内发病率和死亡率较高的疾病，但对于再次发生AMI行直接经皮冠状动脉介入治疗（PCI）后院内结局的预测因素仍不明确。
利用AMI-京都多中心风险研究数据库，对既往有心肌梗死（MI）的接受直接PCI治疗的AMI患者（复发性MI患者，n=235）和无既往MI的患者（首次MI患者，n=1550）的临床背景、血管造影结果、直接PCI结果及院内预后进行回顾性比较。复发性MI患者入院时Killip分级≥3级的患病率更高、病变血管数量更多，且院内死亡率显著高于首次MI患者。多因素分析显示，初始冠状动脉造影时病变血管数量≥2支或左主干（LMT）病变是复发性MI患者而非首次MI患者院内死亡的独立阳性预测因素，而直接PCI后梗死相关动脉立即获得心肌梗死溶栓治疗（TIMI）3级血流以及发病时间<24小时是首次MI患者而非复发性MI患者的阴性预测因素。
初始冠状动脉造影时病变血管数量≥2支或LMT病变是接受直接PCI的复发性AMI患者院内死亡的独立危险因素。
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