Department of Cardiology, University of Fribourg, Fribourg, Switzerland.
EuroIntervention. 2011 Oct 30;7(6):697-704. doi: 10.4244/EIJV7I6A112.
Unprotected left main (ULM) coronary artery disease is encountered in 3%-10% of coronary angiograms and is associated with high mortality. The survival of patients with ULM disease presenting with acute coronary syndromes (ACS) depends on different variables and is lowest in those with cardiogenic shock (CS). The aim of the present study was to estimate the impact of baseline characteristics on the subsequent clinical outcome in patients treated by percutaneous coronary intervention (PCI) of ULM for ACS.
One hundred and thirty-four patients were retrieved from our database and followed by phone or physician visit. Patients were classified into two groups according to their presentation (CS/STEMI group: patients presenting with CS or ST-elevation myocardial infarction; NSTEMI/UA group: patients with non-STEMI or unstable angina). Data collected were baseline characteristics, procedural information, and clinical outcome. The primary endpoint was all-cause mortality at 6-month follow-up. The secondary end point was a composite of cardiac death, myocardial infarction, and any repeat revascularisation, i.e., major adverse cardiac events (MACE). Kaplan-Meier curves were computed for survival. Logistic regression determined that hypercholesterolaemia (OR 6.22, p=0.03), high pre-procedural TIMI score (OR 3.89, p=0.01), preserved left ventricular ejection fraction (OR 1.07, p=0.01) and LM as culprit lesion (OR 8.57, p=0.01) protected against development of CS. Primary outcome occurred in 44% of patients in the CS/STEMI group compared to 6% in the NSTEMI/UA group (p<0.001). MACE were observed in 30 patients (48%) of the CS/STEMI group and in 12 patients (19%) of the NSTEMI/UA group (p=0.001).
Acute coronary syndrome due to critical ULM stenosis is associated with high mortality even after successful PCI. Patients presenting with CS or STEMI are at particular risk.
无保护左主干（ULM）冠状动脉疾病在冠状动脉造影中占 3%-10%，与高死亡率相关。急性冠状动脉综合征（ACS）患者的 ULM 疾病的生存率取决于不同的变量，在伴有心源性休克（CS）的患者中最低。本研究的目的是评估基线特征对接受经皮冠状动脉介入治疗（PCI）的 ULM 治疗 ACS 患者后续临床结局的影响。
从我们的数据库中检索了 134 例患者，并通过电话或医生访视进行随访。根据患者的表现（CS/STEMI 组：出现 CS 或 ST 段抬高心肌梗死的患者；NSTEMI/UA 组：非 ST 段抬高心肌梗死或不稳定型心绞痛患者）将患者分为两组。收集的数据包括基线特征、手术信息和临床结局。主要终点是 6 个月随访时的全因死亡率。次要终点是心脏死亡、心肌梗死和任何再次血运重建的复合终点，即主要不良心脏事件（MACE）。绘制了生存的 Kaplan-Meier 曲线。逻辑回归确定高胆固醇血症（OR 6.22，p=0.03）、高术前 TIMI 评分（OR 3.89，p=0.01）、保留的左心室射血分数（OR 1.07，p=0.01）和 LM 为罪犯病变（OR 8.57，p=0.01）可预防 CS 的发生。CS/STEMI 组中有 44%的患者发生主要结局，而 NSTEMI/UA 组中仅有 6%的患者发生（p<0.001）。CS/STEMI 组中有 30 例（48%）患者发生 MACE，而 NSTEMI/UA 组中有 12 例（19%）患者发生 MACE（p=0.001）。
由严重 ULM 狭窄引起的急性冠状动脉综合征即使在成功的 PCI 后也与高死亡率相关。出现 CS 或 STEMI 的患者风险特别高。
