三维超声心动图研究左心室功能与冠状动脉优势的相关性在预测直接经皮冠状动脉介入治疗结果中的价值。
Value of three-dimensional echocardiography study of left ventricle function correlated to coronary arterial dominance in predicting the outcome of primary percutaneous coronary intervention.
作者信息
Hanboly Noha Hassanin, Baghdady Yasser Mohamed, Diab Reda Huissen, Lawend Sameeh Ramadan, Kenawy Ahmed Abdelazim
机构信息
Cardiovascular Department , Cairo University, Cairo, Egypt.
Cardiovascular Medicine King Saud University, Riyadh, Saudi Arabia.
出版信息
J Saudi Heart Assoc. 2018 Jul;30(3):211-221. doi: 10.1016/j.jsha.2018.01.001. Epub 2018 Jan 11.
BACKGROUND
Limited information is available regarding the relationship between coronary vessel dominance and outcome after ST-segment elevation myocardial infarction (STEMI).
OBJECTIVES
The study was designed to evaluate the prognostic value of coronary arterial dominance after primary percutaneous coronary intervention (PCI) during hospital stay and at 3 months follow-up regarding cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke.
PATIENTS AND METHODS
The study population consisted of 300 consecutive patients (mean age, 57.35 ± 13.41 years; 91% men) with STEMI who were admitted to Dallah Hospital (Riyadh, Saudi Arabia) from January 2015 to December 2016. These patients underwent successful primary PCI with thrombolysis in myocardial infarction (TIMI) III flow. They were divided into three groups according to angiographic coronary dominance: 227 (75.7%) in the right coronary dominant group, 40 (13.3%) in the left coronary dominant group, and 33 (11%) in the balanced coronary dominant group. They were evaluated with two- (2D) and three-dimensional (3D) echocardiography within 48 hours of admission and at 3 months follow-up after STEMI.
RESULTS
Right dominance was present in 75.6%, left dominance in 13.3%, and balanced dominance was present in 11% of patients. The main finding of this study was that a left dominant system was associated with increased risk of cardiac mortality, heart failure, nonfatal myocardial infarction, revascularization, and stroke shortly after primary PCI, during hospital stay, and at 3 months follow-up after STEMI. Moreover, a significantly lower left ventricular ejection fraction at admission was observed by both 2D and 3D echocardiography in patients with a left dominant system.
CONCLUSION
In patients with STEMI treated with primary PCI, left coronary artery dominance confers a higher risk of various adverse clinical events after primary PCI, during hospital stay, and at 3 months follow-up compared to right and balanced coronary artery dominance.
背景
关于冠状动脉优势与ST段抬高型心肌梗死（STEMI）后预后之间的关系，现有信息有限。
目的
本研究旨在评估在住院期间及3个月随访时，初次经皮冠状动脉介入治疗（PCI）后冠状动脉优势对心脏死亡率、心力衰竭、非致死性心肌梗死、血运重建及卒中的预后价值。
患者与方法
研究对象为2015年1月至2016年12月期间连续入住达勒医院（沙特阿拉伯利雅得）的300例STEMI患者（平均年龄57.35±13.41岁；91%为男性）。这些患者成功接受了初次PCI，心肌梗死溶栓治疗（TIMI）血流达3级。根据冠状动脉造影优势将他们分为三组：右冠状动脉优势组227例（75.7%），左冠状动脉优势组40例（13.3%），均衡冠状动脉优势组33例（11%）。在入院48小时内及STEMI后3个月随访时，采用二维（2D）和三维（3D）超声心动图对他们进行评估。
结果
75.6%的患者为右优势，13.3%为左优势，11%为均衡优势。本研究的主要发现是，在初次PCI后不久、住院期间及STEMI后3个月随访时，左优势系统与心脏死亡率、心力衰竭、非致死性心肌梗死、血运重建及卒中风险增加相关。此外，2D和3D超声心动图均显示，左优势系统患者入院时左心室射血分数显著更低。
结论
在接受初次PCI治疗的STEMI患者中，与右冠状动脉优势和均衡冠状动脉优势相比，左冠状动脉优势在初次PCI后、住院期间及3个月随访时发生各种不良临床事件的风险更高。
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