Medical Clinic II, University Heart Center Lübeck, Lübeck.
EuroIntervention. 2018 Jun 8;14(3):e306-e313. doi: 10.4244/EIJ-D-17-00451.
The aim of the current study was to investigate the impact of a chronic total occlusion (CTO) in a non-infarct-related coronary artery (non-IRA) on one-year mortality and occurrence of cardiac arrhythmia in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI).
In a retrospective sub-analysis of the Intraaortic Balloon Pump in Cardiogenic Shock II trial (IABP-SHOCK II) and its accompanying registry, 201 (26%) of 761 patients had a CTO in a non-IR major coronary artery. Mortality was significantly higher in the CTO group at day of admission (19% vs. 11%; p=0.005), 30 days (53% vs. 41%, p=0.002), and 12 months (63% vs. 51%, p=0.002). In the adjusted multivariate Cox regression analysis, a CTO in a non-IRA was an independent predictor of mortality at 12 months (hazard ratio 1.30, 95% confidence interval [CI]: 1.02-1.67, p=0.03). At 30-day follow-up, ventricular arrhythmias requiring defibrillation occurred more frequently in patients with non-IRA CTO in the univariate analysis (33% vs. 21%, odds ratio 1.83, 95% CI: 1.28-2.62, p=0.002).
In patients with CS complicating AMI, the presence of CTO in a non-IRA is associated with a higher incidence of ventricular arrhythmias and is an independent predictor of mortality at 12-month follow-up.
本研究旨在探讨非梗死相关冠状动脉（非 IRA）慢性完全闭塞（CTO）对合并急性心肌梗死（AMI）所致心源性休克（CS）患者一年死亡率和心律失常发生的影响。
在主动脉内球囊泵治疗心源性休克 II 试验（IABP-SHOCK II）及其伴随的登记研究的回顾性亚分析中，761 例患者中有 201 例（26%）非 IRA 主要冠状动脉存在 CTO。入院当天（19% vs. 11%；p=0.005）、第 30 天（53% vs. 41%，p=0.002）和第 12 个月（63% vs. 51%，p=0.002）时，CTO 组的死亡率明显更高。在调整后的多变量 Cox 回归分析中，非 IRA 中的 CTO 是 12 个月时死亡的独立预测因素（危险比 1.30，95%置信区间 [CI]：1.02-1.67，p=0.03）。在第 30 天随访时，在单变量分析中，非 IRA CTO 患者更频繁发生需要除颤的室性心律失常（33% vs. 21%，优势比 1.83，95%CI：1.28-2.62，p=0.002）。
在合并 AMI 的 CS 患者中，非 IRA 中的 CTO 与更高的室性心律失常发生率相关，是 12 个月随访时死亡的独立预测因素。
