Vakili Hossein, Sadeghi Roxana, Rezapoor Parisa, Gachkar Latif
Associate Professor, Department of Interventional Cardiology AND Cardiovascular Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Assistant Professor, Department of Interventional Cardiology AND Cardiovascular Research Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
ARYA Atheroscler. 2014 Jul;10(4):211-7.
The primary objective of primary percutaneous coronary intervention (pPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is not only to restore the blood flow in the infarct-related artery, but also to save the patients' quality and duration of their life. Since left ventricular ejection fraction (LVEF) is a known predictor of clinical outcomes in STEMI patients, the possible association between characteristics of a large group of patients who undergo pPCI with LVEF and death was evaluated.
This prospective cohort study included 304 patients who had undergone pPCI between 2009 and 2011. The association between LVEF and in-hospital outcomes of patients was assessed.
LVEF ≤ 25%, 25% < LVEF < 50%, and LVEF ≥ 50% were presented in 23 (7.6%), 150 (49.3%), and 128 (42.1%) of the patients, respectively. Three patients (0.01%) died before echocardiography. There was no significant difference among aforementioned three groups regarding baseline characteristics, except age (P = 0.012) and sex (P = 0.016). Cumulative number of cardiogenic shock and death were 7 (2.3%) and 22 (7.2%), respectively; with significant differences between three LVEF groups. Age more than 70 years old, pulmonary edema, systolic blood pressure < 100 mm Hg, shock, post-PCI thrombolysis in myocardial infarction (MI) flow grade, corrected thrombolysis in MI frame count, angiographic success and ST-segment resolution showed significant association with death (P < 0.050).
This study not only demonstrates that LVEF ≤ 50% is associated with a higher incidence of in-hospital adverse events, but also identifies characteristics that are strongly correlated with the risk of LVEF ≤ 50% and death after pPCI.
急性ST段抬高型心肌梗死（STEMI）患者进行直接经皮冠状动脉介入治疗（pPCI）的主要目标不仅是恢复梗死相关动脉的血流，还在于挽救患者的生活质量和生命长度。由于左心室射血分数（LVEF）是STEMI患者临床结局的已知预测指标，因此评估了接受pPCI的一大组患者的特征与LVEF及死亡之间的可能关联。
这项前瞻性队列研究纳入了2009年至2011年间接受pPCI的304例患者。评估了LVEF与患者院内结局之间的关联。
LVEF≤25%、25%＜LVEF＜50%和LVEF≥50%的患者分别有23例（7.6%）、150例（49.3%）和128例（42.1%）。3例患者（0.01%）在超声心动图检查前死亡。除年龄（P = 0.012）和性别（P = 0.016）外，上述三组患者的基线特征无显著差异。心源性休克和死亡的累积例数分别为7例（2.3%）和22例（7.2%）；三个LVEF组之间存在显著差异。年龄大于70岁、肺水肿、收缩压＜100 mmHg、休克、PCI术后心肌梗死（MI）血流分级、校正的MI帧数、血管造影成功和ST段回落与死亡显著相关（P＜0.050）。
本研究不仅表明LVEF≤50%与院内不良事件发生率较高相关，还确定了与pPCI后LVEF≤50%及死亡风险密切相关的特征。
