Qin Qing, Qian Juying, Fan Bing, Ge Lei, Ge Junbo
Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China.
J Invasive Cardiol. 2015 Aug;27(8):E153-7.
Patients with acute myocardial infarction (AMI) with unprotected left main coronary artery (ULMCA) as culprit lesion are a high-risk subgroup with a substantial mortality. Percutaneous coronary intervention (PCI) has become an option for these patients, but the data are limited. We therefore analyzed the clinical characteristics and the short-term and long-term outcomes of this subgroup of patients.
This is a retrospective, single-center, observational study with 30 AMI patients admitted between July 2005 and March 2013 and treated with emergency PCI to an ULMCA culprit lesion.
Twenty-four males and 6 females with an average age of 63 ± 17 years were enrolled. Nineteen patients (63.3%) presented with ST-segment elevation MI, while 11 patients presented with non-ST segment elevation MI. Cardiac shock was present in 8 patients, total occlusion of left main coronary artery was identified by coronary angiography in 13 patients, and coexisting right coronary artery disease was present in 10 patients. Angiographic procedural success was achieved in 93% of patients, with intraaortic balloon pump used in 9 patients. Overall in-hospital mortality was 20%, all secondary to refractory cardiogenic shock and multiorgan failure. During a follow-up period of 1099 ± 819 days, no deaths or MIs were detected. Probability of freedom from death at 3 years was 79.7 ± 7.4%.
We demonstrate that in patients with LMCA disease in the setting of AMI, PCI is a feasible treatment option with an in-hospital survival of 80%. The long-term clinical outcome of patients surviving to hospital discharge is excellent.
以无保护左主干冠状动脉（ULMCA）作为罪犯病变的急性心肌梗死（AMI）患者是一个具有高死亡率的高危亚组。经皮冠状动脉介入治疗（PCI）已成为这些患者的一种选择，但相关数据有限。因此，我们分析了该亚组患者的临床特征以及短期和长期预后。
这是一项回顾性、单中心观察性研究，纳入了2005年7月至2013年3月期间收治的30例AMI患者，这些患者接受了针对ULMCA罪犯病变的急诊PCI治疗。
纳入24例男性和6例女性，平均年龄63±17岁。19例患者（63.3%）表现为ST段抬高型心肌梗死，11例患者表现为非ST段抬高型心肌梗死。8例患者出现心源性休克，13例患者经冠状动脉造影证实左主干冠状动脉完全闭塞，10例患者并存右冠状动脉疾病。93%的患者血管造影手术成功，9例患者使用了主动脉内球囊泵。总体住院死亡率为20%，均继发于难治性心源性休克和多器官功能衰竭。在1099±819天的随访期内，未检测到死亡或心肌梗死。3年时无死亡的概率为79.7±7.4%。
我们证明，对于AMI合并左主干冠状动脉疾病的患者，PCI是一种可行的治疗选择，住院生存率为80%。存活至出院的患者长期临床预后良好。
