接受直接经皮冠状动脉介入治疗的急性前壁心肌梗死患者左心室血栓形成与不良结局的关系
Relationship of left ventricular thrombus formation and adverse outcomes in acute anterior myocardial infarction in patients treated with primary percutaneous coronary intervention.
作者信息
Zhang Qian, Wang Chun-Mei, Shi Shu-Tian, Chen Hong, Zhou Yu-Jie
机构信息
Department of Emergency, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China.
出版信息
Clin Cardiol. 2019 Jan;42(1):69-75. doi: 10.1002/clc.23106. Epub 2018 Nov 30.
BACKGROUND
The incidence of left ventricular thrombus (LVT) is 4% to 15% in patients with anterior acute ST-segment elevation myocardial infarction (ant-AMI) in the era of primary percutaneous coronary intervention (PPCI). And patients with LVT have higher in-hospital mortality.
HYPOTHESIS
There is a relationship between LVT formation and 1-year major adverse cardio-cerebrovascular events (MACCE) in patients with ant-AMI treated by PPCI.
METHODS
Our study population included 1488 consecutive patients with ant-AMI. The primary endpoint was the incidence of MACCE within 1 year after AMI. The secondary endpoint was the thrombosis disappearance.
RESULTS
A total of 106 (7.1%) patients were diagnosed with LVT and 1382 (92.9%) patients without LVT. Patients with LVT had a higher incidence of MACCE than in patients without LVT (21.7%vs10.3%; P < 0.001). Univariate analysis showed LVT was associated with an increase in MACCE risk (odds ratio [OR] = 2.40; 95% confidence interval [CI] [1.37-4.21]; P < 0.001). When examining MACCE components individually, LVT was only associated with the incidence of congestive heart failure (OR = 2.41; 95% CI [1.29-4.58]; P = 0.001). After adjustment for principal confounders, LVT remained an independent risk factor for MACCE (HR = 2.28; 95% CI [1.12-6.38]; P = 0.020). Other independent predictors include 24-hour LVEF, creatine kinase peak value, and age. Further analysis found patients with LVT in international normalized ratio (INR) ≥ 2 group had lower MACCE risk and higher thrombus disappearance than in INR < 2 group (13.5%vs29.6%; P = 0.044; 90.4%vs74.1%; P = 0.029).
CONCLUSION
For patients with ant-AMI treated by PPCI, LVT is an independent predictor of 1-year MACCE events. Treatment with vitamin K antagonist in the therapeutic range (INR ≥ 2) has the potential to reduce MACCE risk and promote disappearance of thrombus.
背景
在直接经皮冠状动脉介入治疗（PPCI）时代，前壁急性ST段抬高型心肌梗死（前壁AMI）患者左心室血栓（LVT）的发生率为4%至15%。LVT患者的院内死亡率更高。
假设
在接受PPCI治疗的前壁AMI患者中，LVT形成与1年主要不良心脑血管事件（MACCE）之间存在关联。
方法
我们的研究人群包括1488例连续的前壁AMI患者。主要终点是AMI后1年内MACCE的发生率。次要终点是血栓消失情况。
结果
共有106例（7.1%）患者被诊断为LVT，1382例（92.9%）患者未发生LVT。LVT患者的MACCE发生率高于未发生LVT的患者（21.7%对10.3%；P<0.001）。单因素分析显示LVT与MACCE风险增加相关（比值比[OR]=2.40；95%置信区间[CI][1.37 - 4.21]；P<0.001）。单独检查MACCE各组成部分时，LVT仅与充血性心力衰竭的发生率相关（OR = 2.41；95%CI[1.29 - 4.58]；P = 0.001）。在对主要混杂因素进行调整后，LVT仍然是MACCE的独立危险因素（HR = 2.28；95%CI[1.12 - 6.38]；P = 0.020）。其他独立预测因素包括24小时左心室射血分数、肌酸激酶峰值和年龄。进一步分析发现，国际标准化比值（INR）≥2组的LVT患者比INR<2组的MACCE风险更低且血栓消失率更高（13.5%对29.6%；P = 0.044；90.4%对74.1%；P = 0.029）。
结论
对于接受PPCI治疗的前壁AMI患者，LVT是1年MACCE事件的独立预测因素。在治疗范围内（INR≥2）使用维生素K拮抗剂治疗有可能降低MACCE风险并促进血栓消失。
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