Mizuguchi Yukio, Takahashi Akihiko, Hashimoto Sho, Yamada Takeshi, Taniguchi Norimasa, Nakajima Shunsuke, Hata Tetsuya
Department of Cardiovascular, Sakurakai Takahashi Hospital.
Int Heart J. 2015;56(6):592-6. doi: 10.1536/ihj.15-080. Epub 2015 Nov 6.
Chronic total occlusion (CTO) in a non-infarcted-related artery was reported to worsen immediate clinical outcome in acute myocardial infarction (AMI) patients. However, the prognosis of such patients with preserved left ventricular function after successful primary percutaneous coronary intervention (PCI) has not yet been clarified. The aim of the present study was to evaluate whether the presence of CTO contributes to a worse prognosis even in patients with preserved left ventricular function after primary PCI.We retrospectively analyzed 353 consecutive patients with acute myocardial infarction, whose left ventricular ejection fraction (LVEF) was not less than 40% in the echocardiography performed 1 day after primary PCI. We divided the patients into two groups according to the presence (n = 25) or absence (n = 328) of CTO in the non-infarct-related coronary artery, and compared the clinical outcome of patients between the two groups.The LVEF estimated by echocardiography after primary PCI was similar between patients with and without CTO (55.1 ± 8.6% versus 58.0 ± 9.4%; P = 0.07). The peak creatine kinase value was also similar between the two groups (1539 versus 1921 U/L; P = 0.33); however, CTO patients were significantly more likely to undergo intra-aortic balloon pumping (56.0% versus 12.5%; P < 0.001) during primary PCI, and 30-day mortality was significantly higher in CTO patients (12.0% versus 0.9%; P < 0.001). By multivariate analysis, cardiogenic shock at arrival was significantly correlated with 30-day mortality.Even though the LVEF of AMI patients with CTO was preserved after successful PCI, a high mortality rate was observed.
据报道，非梗死相关动脉的慢性完全闭塞（CTO）会使急性心肌梗死（AMI）患者的近期临床结局恶化。然而，对于这些在成功进行直接经皮冠状动脉介入治疗（PCI）后左心室功能保留的患者的预后情况尚未明确。本研究的目的是评估即使在直接PCI后左心室功能保留的患者中，CTO的存在是否会导致更差的预后。我们回顾性分析了353例连续的急性心肌梗死患者，这些患者在直接PCI术后1天进行的超声心动图检查中左心室射血分数（LVEF）不低于40%。我们根据非梗死相关冠状动脉中是否存在CTO将患者分为两组（存在CTO组n = 25，不存在CTO组n = 328），并比较两组患者的临床结局。直接PCI术后通过超声心动图估计的LVEF在有CTO和无CTO的患者之间相似（55.1±8.6%对58.0±9.4%；P = 0.07）。两组之间的肌酸激酶峰值也相似（1539对1921 U/L；P = 0.33）；然而，CTO患者在直接PCI期间接受主动脉内球囊泵血的可能性显著更高（56.0%对12.5%；P < 0.001），并且CTO患者的30天死亡率显著更高（12.0%对0.9%；P < 0.001）。通过多变量分析，入院时的心源性休克与30天死亡率显著相关。尽管成功PCI后CTO的AMI患者的LVEF得以保留，但仍观察到较高的死亡率。
