Ağaç Mustafa Tarık, Ağaç Süret, Korkmaz Levent, Erkan Hakan, Turan Turhan, Bektaş Hüseyin, Akyüz Ali Rıza, Çetin Mustafa, Çelik Sükrü
Department of Cardiology, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey.
Department of Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
Turk Kardiyol Dern Ars. 2014 Jun;42(4):321-9. doi: 10.5543/tkda.2014.02154.
The major determinant of final infarct size for a given coronary occlusion is the size of the myocardial area-at-risk. We propose herein a new index 'Relative Importance Index (RII)' to predict area-at-risk in patients with anterior myocardial infarction (MI). The aim of the study was to assess the predictive value of RII in left ventricle (LV) systolic function reduction and its relation to adverse clinical outcome.
One hundred twenty-three acute anterior MI patients with their first acute coronary syndrome incident were consecutively and prospectively enrolled in to the study. RII was calculated by dividing the culprit segment diameter by the sum of diameters of the left anterior descending, circumflex, and right coronary arteries at their proximal segments. We evaluated the one-month follow-up rates of major clinical endpoints, which were defined as death, non-fatal MI, stroke, and new congestive heart failure (CHF).
RII was significantly and negatively correlated with left ventricular ejection fraction (LVEF) (r=-0.65, p<0.001). Likewise, RII was significantly correlated with 72 hour troponin I (TnI) (r=0.48, p<0.001). Patients were dichotomized according to the median value of RII (median RII: 0.30). Supra-median RII was associated with lower EF (32.8±8.6 vs. 42.8±9.4, p<0.001) and higher incidence of composite major adverse cardiac events (33.9% vs. 13.1%, p=0.01). The mortality, non-fatal MI and new CHF rates in the supra-median RII group trended higher but they did not reach statistical significance. An RII >0.30 had an 88% sensitivity and 60% specificity (ROC area: 0.82, p<0.001, CI: 0.73-0.90) for predicting severe LV dysfunction (LVEF<30%).
A simple index derived from coronary angiography at the time of primary percutaneous coronary intervention can predict LV systolic function loss and adverse clinical outcome in patients with acute anterior MI.
对于给定的冠状动脉闭塞，最终梗死面积的主要决定因素是心肌危险区的大小。我们在此提出一种新的指标“相对重要性指数（RII）”，以预测前壁心肌梗死（MI）患者的危险区。本研究的目的是评估RII对左心室（LV）收缩功能降低的预测价值及其与不良临床结局的关系。
123例首次发生急性冠状动脉综合征的急性前壁MI患者连续且前瞻性地纳入本研究。RII通过将罪犯血管节段直径除以左前降支、回旋支和右冠状动脉近端节段直径之和来计算。我们评估了主要临床终点的1个月随访率，主要临床终点定义为死亡、非致命性MI、中风和新发充血性心力衰竭（CHF）。
RII与左心室射血分数（LVEF）显著负相关（r = -0.65，p < 0.001）。同样，RII与72小时肌钙蛋白I（TnI）显著相关（r = 0.48，p < 0.001）。根据RII的中位数（中位数RII：0.30）将患者分为两组。RII高于中位数与较低的EF（32.8±8.6对42.8±9.4，p < 0.001）和较高的复合主要不良心脏事件发生率相关（33.9%对13.1%，p = 0.01）。RII高于中位数组的死亡率、非致命性MI和新发CHF率有升高趋势，但未达到统计学意义。RII>0.30对预测严重左心室功能障碍（LVEF<30%）的敏感性为88%，特异性为60%（ROC曲线下面积：0.82，p < 0.001，CI：0.73 - 0.90）。
在初次经皮冠状动脉介入治疗时从冠状动脉造影得出的一个简单指标可以预测急性前壁MI患者的左心室收缩功能丧失和不良临床结局。
