Sim Doo Sun, Ahn Youngkeun, Jeong Myung Ho, Kim Young Jo, Chae Shung Chull, Hong Taek Jong, Seong In Whan, Chae Jei Keon, Kim Chong Jin, Cho Myeong Chan, Seung Ki Bae
Chonnam National University Hospital, Gwangju, Republic of Korea.
Int Heart J. 2013;54(4):185-91. doi: 10.1536/ihj.54.185.
The clinical outcome of patients with acute myocardial infarction (MI) with unprotected left main coronary artery (LMCA) stenosis is not fully understood. We sought to assess the outcomes of patients with acute MI who underwent percutaneous coronary intervention (PCI) for unprotected LMCA stenosis. A total of 587 patients enrolled in the Korea Acute Myocardial Infarction Registry with LMCA stenosis were analyzed. Patients with culprit LMCA had higher inhospital mortality than patients with non-culprit LMCA (16.0% versus 8.9%, P = 0.008), but had similar clinical outcomes during a 12-month follow-up. Compared to CABG, PCI using drug-eluting stents (DES) was more frequently performed with similar early and 12-month clinical outcomes. The efficacy of sirolimus-eluting stents, paclitaxel-eluting stents, and zotarolimus-eluting stents were comparable at 12-month clinical follow-up. Predictors of 12-month mortality included mechanical ventilation, cardiogenic shock, age > 65 years, and ejection fraction < 40%. Patients with acute MI and culprit LMCA have higher early mortality than patients with non-culprit LMCA. PCI with DES is frequently performed and the clinical outcome is similar between the 3 types of first-generation DES.
急性心肌梗死（MI）合并无保护左主干冠状动脉（LMCA）狭窄患者的临床结局尚未完全明确。我们旨在评估因无保护LMCA狭窄而接受经皮冠状动脉介入治疗（PCI）的急性MI患者的结局。对韩国急性心肌梗死注册研究中纳入的共587例合并LMCA狭窄的患者进行了分析。罪犯血管为LMCA的患者住院死亡率高于非罪犯血管为LMCA的患者（16.0%对8.9%，P = 0.008），但在12个月随访期间临床结局相似。与冠状动脉旁路移植术（CABG）相比，使用药物洗脱支架（DES）进行PCI更为频繁，早期和12个月临床结局相似。在12个月临床随访时，西罗莫司洗脱支架、紫杉醇洗脱支架和佐他莫司洗脱支架的疗效相当。12个月死亡率的预测因素包括机械通气、心源性休克、年龄>65岁和射血分数<40%。急性MI且罪犯血管为LMCA的患者早期死亡率高于非罪犯血管为LMCA的患者。DES PCI操作频繁，3种第一代DES之间的临床结局相似。
