Ariza-Solé Albert, Teruel Luis, di Marco Andrea, Lorente Victòria, Sánchez-Salado José C, Sánchez-Elvira Guillermo, Romaguera Rafael, Gómez-Lara Josep, Gómez-Hospital Joan A, Cequier Angel
Unidad Coronaria, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Unidad de Cardiología Intervencionista, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2014 May;67(5):359-66. doi: 10.1016/j.rec.2013.08.012. Epub 2014 Feb 13.
The prognostic value of chronic total occlusion in nonculprit coronary arteries in patients with myocardial infarction undergoing primary angioplasty remains controversial. Several publications have described different methodologies and conflicting findings. In addition, causes of death were not reported. Our aim is to analyze the prognostic impact of chronic total occlusion in nonculprit coronary arteries and the role of left ventricular ejection fraction in this analysis.
Prospective inclusion of consecutive patients with ST-segment elevation myocardial infarction who underwent primary angioplasty. We recorded baseline characteristics, in-hospital clinical course, and mortality and its causes during follow-up. We assessed the impact of chronic total occlusion on mortality using Cox regression analysis.
Chronic total occlusion in nonculprit arteries was present in 125 of 1176 patients (10.6%); in 79 of these 125 patients, chronic total occlusion was present in the proximal segments. The mean follow-up was 339 days; 64 (5.8%) patients died during the first 6 months. Patients with chronic total occlusions had more comorbidities, poorer ventricular function, and higher mortality (hazard ratio=2.79; 95% confidence interval, 1.71-4.56). Chronic total occlusion was also associated with noncardiac death (hazard ratio=3.83; 95% confidence interval, 2.10-7.01). Chronic total occlusion in proximal segments was associated with both cardiac (hazard ratio=3.22; 95% confidence interval, 1.42-7.30) and noncardiac deaths (hazard ratio=3.43; 95% confidence interval, 1.67-7.06). The multivariate analysis performed without including left ventricular ejection fraction showed a significant association between chronic total occlusion and mortality. However, when left ventricular ejection fraction was included in the analysis, this association was nonsignificant (hazard ratio=1.76; 95% confidence interval, 0.85-3.65; P=.166).
Chronic total occlusion in this clinical setting identified patients at higher risk with more comorbidities and higher mortality, but did not behave as an independent predictor of mortality when left ventricular ejection fraction was included in the analysis.
在接受直接血管成形术的心肌梗死患者中，非罪犯冠状动脉慢性完全闭塞的预后价值仍存在争议。一些出版物描述了不同的方法和相互矛盾的结果。此外，未报告死亡原因。我们的目的是分析非罪犯冠状动脉慢性完全闭塞的预后影响以及左心室射血分数在该分析中的作用。
前瞻性纳入连续的接受直接血管成形术的ST段抬高型心肌梗死患者。我们记录了基线特征、住院临床过程以及随访期间的死亡率及其原因。我们使用Cox回归分析评估慢性完全闭塞对死亡率的影响。
1176例患者中有125例（10.6%）存在非罪犯动脉慢性完全闭塞；在这125例患者中的79例中，近端节段存在慢性完全闭塞。平均随访339天；64例（5.8%）患者在最初6个月内死亡。慢性完全闭塞患者合并症更多、心室功能更差且死亡率更高（风险比=2.79；95%置信区间，1.71 - 4.56）。慢性完全闭塞也与非心源性死亡相关（风险比=3.83；95%置信区间，2.10 - 7.01）。近端节段的慢性完全闭塞与心源性（风险比=3.22；95%置信区间，1.42 - 7.30）和非心源性死亡（风险比=3.43；95%置信区间，1.67 - 7.06）均相关。在不纳入左心室射血分数的情况下进行的多变量分析显示慢性完全闭塞与死亡率之间存在显著关联。然而，当分析中纳入左心室射血分数时，这种关联不显著（风险比=1.76；95%置信区间，0.85 - 3.65；P = 0.166）。
在这种临床情况下，慢性完全闭塞识别出了合并症更多、死亡率更高的高风险患者，但在分析中纳入左心室射血分数时，它并非死亡率的独立预测因素。
