Örebro University, Faculty of Health, Department of Cardiology, Sweden.
Örebro University, Faculty of Health, Department of Cardiology, Sweden.
Int J Cardiol. 2018 Jun 15;261:6-11. doi: 10.1016/j.ijcard.2018.02.035.
The role of systemic atherosclerosis in myocardial infarction (MI) patients is not fully understood. We investigated the incremental prognostic value of coronary and systemic atherosclerosis after acute MI by estimating extra-cardiac artery disease (ECAD) and extent of coronary atherosclerosis.
The study included 544 prospective MI patients undergoing coronary angiography. For all patients, the longitudinal coronary atherosclerotic extent, expressed as Sullivan extent score (SES) was calculated. In addition, the patients underwent non-invasive screening for ECAD in the carotid, aortic, renal and lower limb. SES was found to be associated with ECAD independent of baseline clinical parameters [adjusted odds ratio (OR) 1.04 95% confidence interval (CI) 1.02-1.06, P < 0.001]. Extensive systemic atherosclerosis, defined as the combination of extensive coronary disease (SES ≥ 17) and ECAD, was associated with higher risk for all-cause mortality compared to limited systemic atherosclerosis (SES < 17 and no ECAD) (hazard ratio [HR] 2.9 95% CI 1.9-4.5, P < 0.001, adjusted for Global Registry of Acute Coronary Events risk score parameters 1.8, 95% CI 1.1-3.0, P = 0.019). The risk for the composite endpoint of cardiovascular death or hospitalization was significantly higher in patients with extensive systemic atherosclerosis compared to patients with limited systemic atherosclerosis (HR 3.1, 95% CI 2.1-4.7, P < 0.001, adjusted HR 1.9, 95% CI 1.2-3.1, P < 0.004).
Visual estimation of the longitudinal coronary atherosclerotic extent at the time of MI predicts ECAD. Coexistence of extensive coronary disease and ECAD defines a group with particularly poor prognosis after MI.
系统性动脉粥样硬化在心肌梗死（MI）患者中的作用尚未完全阐明。我们通过评估心脏外动脉疾病（ECAD）和冠状动脉粥样硬化程度，研究急性 MI 后冠状动脉和系统性动脉粥样硬化的预后增值作用。
本研究纳入 544 例接受冠状动脉造影的前瞻性 MI 患者。对所有患者，计算纵向冠状动脉粥样硬化程度，用 Sullivan 程度评分（SES）表示。此外，患者还接受了颈动脉、主动脉、肾和下肢的 ECAD 无创筛查。SES 与 ECAD 独立相关，与基线临床参数无关[校正比值比（OR）1.04，95%置信区间（CI）1.02-1.06，P < 0.001]。广泛的系统性动脉粥样硬化定义为广泛的冠状动脉疾病（SES≥17）和 ECAD 的组合，与全因死亡率的风险增加相关，与有限的系统性动脉粥样硬化（SES < 17 和无 ECAD）相比（危险比[HR]2.9，95% CI 1.9-4.5，P < 0.001，调整全球急性冠状动脉事件登记风险评分参数后 1.8，95% CI 1.1-3.0，P = 0.019）。与有限的系统性动脉粥样硬化相比，广泛的系统性动脉粥样硬化患者发生心血管死亡或住院的复合终点的风险显著增加（HR 3.1，95% CI 2.1-4.7，P < 0.001，调整 HR 1.9，95% CI 1.2-3.1，P < 0.004）。
MI 时纵向冠状动脉粥样硬化程度的视觉评估可预测 ECAD。广泛的冠状动脉疾病和 ECAD 的共存定义了 MI 后预后特别差的患者群体。
