Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
Catheter Cardiovasc Interv. 2012 Jun 1;79(7):1111-6. doi: 10.1002/ccd.23396. Epub 2012 Jan 10.
We determined the in-hospital and the long-term outcomes of primary percutaneous coronary intervention (PCI) for acute left main coronary artery (LMCA) occlusion.
Between 1988 and 2009, 72 patients with acute myocardial infarction (AMI) underwent primary PCI for unprotected LMCA occlusion. The short- and the long-term outcomes of primary PCI in these patients were retrospectively evaluated.
Upon arrival, cardiogenic shock was observed in 33 (46%) patients and cardiopulmonary arrest (CPA) in 12 (17%). Twenty-three (32%) required extracorporeal life support and 64 (89%) intra-aortic balloon pumping. Although successful reperfusion was achieved in 60 (83%) patients, in-hospital death was observed in 32 (44%). Multivariate analysis revealed predictors of in-hospital death to be CPA on arrival (RR, 7.05; 95% CI: 1.28-39.0; P = 0.025). During 1.7 ± 2.9 years of follow-up, 10 of the 40 hospital survivors died. All presenting CPA on arrival died within 2 years. Although the estimated survival of the all study patients was only 26.2% at 8 years by the Kaplan-Meier methods, those without shock/CPA on arrival showed nearly flat survival curve after 4 years.
Despite performance of primary PCI, patients with AMI due to LMCA occlusion were associated with >50% in-hospital mortality. Hemodynamic deficit upon arrival was the major determinant of their poor hospital outcomes. The hospital survivors, however, were associated with favorable long-term outcomes.
我们确定了急性左主干冠状动脉（LMCA）闭塞患者行直接经皮冠状动脉介入治疗（PCI）的院内和长期预后。
1988 年至 2009 年间，72 例急性心肌梗死（AMI）患者因 LMCA 未受保护而行直接 PCI。回顾性评估这些患者直接 PCI 的短期和长期预后。
入院时，33 例（46%）患者出现心源性休克，12 例（17%）患者出现心脏骤停（CPA）。23 例（32%）需要体外生命支持，64 例（89%）需要主动脉内球囊泵。尽管 60 例（83%）患者成功再灌注，但院内死亡 32 例（44%）。多变量分析显示，入院时发生 CPA 是院内死亡的预测因素（RR，7.05；95%CI：1.28-39.0；P=0.025）。在 1.7±2.9 年的随访期间，40 例住院幸存者中有 10 例死亡。所有入院时出现 CPA 的患者均在 2 年内死亡。尽管 Kaplan-Meier 方法估计所有研究患者 8 年时的生存率仅为 26.2%，但入院时无休克/CPA 的患者在 4 年后的生存率几乎呈平坦曲线。
尽管进行了直接 PCI，但因 LMCA 闭塞导致 AMI 的患者院内死亡率仍>50%。入院时的血液动力学缺陷是其不良院内结局的主要决定因素。然而，住院幸存者的长期预后良好。
