Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China.
BMC Cardiovasc Disord. 2020 Mar 4;20(1):108. doi: 10.1186/s12872-020-01386-4.
The management of diagonal branch (D) occlusion is still controversary. The association between the flow loss of D and the prognosis remains unclear. We aim to detect the impact of D flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI).
Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI) at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed.
A total of 392 patients (mean age of 63.9 years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n = 69) and no loss (TIMI grade2-3, n = 323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p = 0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p < 0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI.
Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.
对角支（D）闭塞的处理仍存在争议。D 血流损失与预后之间的关系尚不清楚。我们旨在检测前壁 ST 段抬高型心肌梗死（STEMI）患者 D 血流对心功能和临床结局的影响。
回顾 2015 年 10 月至 2018 年 10 月在我院行直接经皮冠状动脉介入治疗（PCI）的前壁 STEMI 患者。分析前壁 STEMI 患者因左前降支（LAD）闭塞且主 D 血流丢失（TIMI 分级 0-1 或 2-3）或无 D 血流丢失（TIMI 分级 2-3）。分析主要不良心脏事件（MACE，包括全因死亡、靶血管血运重建和再梗死的复合终点）和左心室射血分数（LVEF）的短期和长期发生率。
共纳入 392 例接受直接 PCI 治疗的前壁 STEMI 患者（平均年龄 63.9 岁）。根据直接 PCI 前是否存在 D 血流丢失（TIMI 分级 0-1，n=69；TIMI 分级 2-3，n=323）将患者分为两组。与无 D 血流丢失组相比，D 血流丢失组 PCI 后 LVEF 较低（41.0% vs. 48.8%，p=0.003）。同时，D 血流丢失组住院期间、1 个月和 18 个月的 MACE 发生率较高，尤其是全因死亡率（均 p<0.05）。里程碑分析进一步表明，两组 18 个月结局的显著差异主要是由于住院期间的差异所致。此外，多变量 Cox 比例风险分析发现，直接 PCI 前 D 血流丢失是前壁 STEMI 患者短期和长期结局的独立预测因素。
前壁 STEMI 患者主要 D 血流丢失与住院期间 MACE 发生率和全因死亡率升高以及 LVEF 降低独立相关。
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