Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital Lund, Malmö, Sweden.
Open Heart. 2018 Sep 5;5(2):e000852. doi: 10.1136/openhrt-2018-000852. eCollection 2018.
ST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention (PCI) of STEMI.
A total of 29 832 previously cardiac healthy patients who underwent primary PCI between 2003 and 2014 were prospectively included from the Swedish Coronary Angiography and Angioplasty Registry and the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions. Patients were stratified into three groups based on culprit vessel (right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx)). The primary outcome was 1-year mortality. The secondary outcomes included 30-day and 5-year mortality, as well as heart failure, stroke, bleeding and myocardial reinfarction at 30 days, 1 year and 5 years. Univariable and multivariable analyses were done using Cox regression models.
One-year analyses revealed that LAD infarctions had the highest increased risk of death, heart failure and stroke compared with RCA infarctions, which had the lowest risk. Sensitivity analyses revealed that reduced left ventricular ejection fraction on discharge partially explained this increased relative risk in mortality. Furthermore, landmark analyses revealed that culprit vessel had no significant influence on 1-year mortality if a patient survived 30 days after myocardial infarction. Subgroup analyses revealed female sex and multivessel disease (MVD) as significant high-risk groups with respect to 1-year mortality.
LAD and LCx infarctions had a relatively higher adjusted mortality rate compared with RCA infarctions, with LAD infarctions in particular being associated with an increased risk of heart failure, stroke and death. Culprit vessel had limited influence on mortality after 1 month. High-risk patient groups include LAD infarctions in women or with concomitant MVD.
ST 段抬高型心肌梗死（STEMI）是由于冠状动脉粥样硬化斑块破裂引起的。关于罪犯血管对硬临床事件发生率的影响，数据有限。本研究探讨了罪犯血管对 STEMI 患者行直接经皮冠状动脉介入治疗（PCI）后的结局的影响。
共前瞻性纳入 2003 年至 2014 年间在瑞典冠状动脉血管造影和血管成形术登记处和瑞典心脏重症监护入院信息和知识登记处接受直接 PCI 的 29832 例既往心脏健康患者。根据罪犯血管（右冠状动脉（RCA）、左前降支（LAD）和左回旋支（LCx））将患者分为三组。主要结局为 1 年死亡率。次要结局包括 30 天和 5 年死亡率，以及 30 天、1 年和 5 年时心力衰竭、卒中和出血及心肌再梗死。采用 Cox 回归模型进行单变量和多变量分析。
1 年分析显示，与 RCA 梗死相比，LAD 梗死的死亡、心力衰竭和卒中等风险增加最高，而 RCA 梗死的风险最低。敏感性分析显示，出院时左心室射血分数降低部分解释了死亡率的这种相对风险增加。此外，关键时间点分析显示，如果患者在心肌梗死后 30 天存活，则罪犯血管对 1 年死亡率无显著影响。亚组分析显示，女性和多血管疾病（MVD）是 1 年死亡率的高危人群。
与 RCA 梗死相比，LAD 和 LCx 梗死的校正死亡率相对较高，特别是 LAD 梗死与心力衰竭、卒中和死亡风险增加相关。罪犯血管在 1 个月后对死亡率的影响有限。高危患者群体包括女性 LAD 梗死或同时伴有 MVD。
