Ilia Reuben, Weinstein Jean Marc, Wolak Arik, Gilutz Harel, Cafri Carlos
Cardiology Department, Soroka Medical Center and Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Catheter Cardiovasc Interv. 2014 Aug 1;84(2):316-20. doi: 10.1002/ccd.24979. Epub 2014 Apr 30.
The left anterior descending artery (LAD) supplies blood to a large part of the myocardium. However, the amount of myocardium supplied varies depending on the length of the LAD and as a result, occlusion of its proximal portion may influence outcome. We investigated the prognosis of patients with anterior wall myocardial infarction as the initial presentation of coronary disease who underwent primary percutaneous coronary intervention (PPCI) in our institution due to isolated proximal LAD occlusion.
We retrospectively analyzed all patients that underwent PPCI in our institution from 2002 to June 2012. The individuals who fulfilled the above criteria constituted the study group. We recorded demographic, clinical, and angiographic data as well as mortality during the study period.
Of 2,532 patients undergoing PPCI, 196 had isolated proximal LAD occlusion. In 112 of them (57%), the LAD wrapped around the apex (group A) and in the remaining 84 (43%), the LAD terminated at or before the apex (group B). At univariate analysis, patients in group A were found to be older (P = 0.04). Over the study period, 28% of patients in group A died in comparison to 2.4% in group B (P < 0.01). When differentiating between cardiac and non-cardiac death, both were also significantly higher in group A (P < 0.01). At multivariate analysis, the strongest predictor of death was long LAD versus shorter LAD (HR 9.1, 95% CI 1.1-76, P = 0.04).
Wrap-around LAD is a strong predictor of prognosis in patients with anterior wall MI undergoing PPCI to isolated proximal LAD occlusion. In addition, those with a shorter LAD have an excellent prognosis.
左前降支动脉（LAD）为大部分心肌供血。然而，其供血的心肌量因LAD长度而异，因此，其近端闭塞可能会影响预后。我们调查了因孤立性近端LAD闭塞在我院接受直接经皮冠状动脉介入治疗（PPCI）的以冠状动脉疾病初发表现为前壁心肌梗死患者的预后情况。
我们回顾性分析了2002年至2012年6月在我院接受PPCI的所有患者。符合上述标准的个体构成研究组。我们记录了研究期间的人口统计学、临床和血管造影数据以及死亡率。
在2532例接受PPCI的患者中，196例存在孤立性近端LAD闭塞。其中112例（57%）LAD环绕心尖（A组），其余84例（43%）LAD在心尖处或之前终止（B组）。单因素分析发现，A组患者年龄较大（P = 0.04）。在研究期间，A组28%的患者死亡，而B组为2.4%（P < 0.01）。区分心源性死亡和非心源性死亡时，A组两者也显著更高（P < 0.01）。多因素分析显示，死亡的最强预测因素是长LAD与短LAD相比（HR 9.1，95%CI 1.1 - 76，P = 0.04）。
对于因孤立性近端LAD闭塞接受PPCI的前壁心肌梗死患者，环绕心尖的LAD是预后的有力预测指标。此外，LAD较短的患者预后良好。
