二尖瓣反流是入院时出现心源性休克的ST段抬高型心肌梗死患者1年死亡率的独立预测因素。

Mitral regurgitation is an independent predictor of 1-year mortality in ST-elevation myocardial infarction patients presenting in cardiogenic shock on admission.

作者信息

Engström Annemarie E, Vis Marije M, Bouma Berto J, Claessen Bimmer E P M, Sjauw Krischan D, Baan Jan, Meuwissen Martijn, Koch Karel T, de Winter Robbert J, Tijssen Jan G P, Piek Jan J, Henriques José P S

机构信息

Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.

出版信息

Acute Card Care. 2010 Jun;12(2):51-7. doi: 10.3109/17482941003802148.

DOI:10.3109/17482941003802148

PMID:20482326

Abstract

BACKGROUND

Cardiogenic shock (CS) remains the most serious complication of acute ST-elevation myocardial infarction (STEMI). Mitral regurgitation (MR) is a frequent complication of STEMI and a well-known predictor of mortality in STEMI without CS. The purpose of this study was to determine the prognostic significance of MR in STEMI patients with CS on admission.

METHODS

Mitral regurgitation was assessed in 147 consecutive STEMI patients with CS on admission and treated by primary percutaneous coronary intervention (PCI). Color Doppler of MR was graded with a 0 to 3 scale (none, n = 26; 1 = mild, n = 62; 2 = moderate, n = 40; 3 = severe, n = 19).

RESULTS

Overall one-year mortality in the study cohort was 27%. One-year mortality was 8%, 23%, 30% and 58% for patients with no, mild, moderate and severe MR respectively (P <0.001). For each grade of MR increase, the odds for mortality increased with 71% (OR: 1.71; 95% CI: 1.02-2.87; P = 0.043) when adjusted for age, gender, previous myocardial infarction, left ventricular ejection fraction (LVEF) <40%, multivessel disease and no-reflow.

CONCLUSIONS

The presence of MR on early echocardiography is an important independent predictor of one-year mortality in STEMI patients with CS on admission treated by primary PCI.

摘要

背景

心源性休克（CS）仍然是急性ST段抬高型心肌梗死（STEMI）最严重的并发症。二尖瓣反流（MR）是STEMI的常见并发症，也是无CS的STEMI患者死亡率的一个众所周知的预测指标。本研究的目的是确定入院时合并CS的STEMI患者中MR的预后意义。

方法

对147例入院时合并CS并接受直接经皮冠状动脉介入治疗（PCI）的连续STEMI患者进行二尖瓣反流评估。MR的彩色多普勒分级为0至3级（无反流，n = 26；1 = 轻度，n = 62；2 = 中度，n = 40；3 = 重度，n = 19）。

结果

研究队列的总体一年死亡率为27%。无MR、轻度MR、中度MR和重度MR患者的一年死亡率分别为8%、23%、30%和58%（P <0.001）。在校正年龄、性别、既往心肌梗死、左心室射血分数（LVEF）<40%、多支血管病变和无复流后，每增加一级MR，死亡几率增加71%（OR：1.71；95%CI：1.02 - 2.87；P = 0.043）。