Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No 8 of Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100021, China.
BMC Cardiovasc Disord. 2021 Jan 30;21(1):59. doi: 10.1186/s12872-021-01874-1.
To investigate the long-term outcome of patients with acute ST-segment elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) and the risk factors for mortality.
The enrolled cohort comprised 323 patients with STEMI and multivessel diseases (MVD) that received a primary percutaneous coronary intervention between January 2008 and November 2013. The patients were divided into two groups: the CTO group (n = 97) and the non-CTO group (n = 236). The long-term major adverse cardiovascular and cerebrovascular events (MACCE) experienced by each group were compared.
The rates of all-cause mortality and MACCE were significantly higher in the CTO group than they were in the non-CTO group. Cox regression analysis showed that an age ≥ 65 years (OR = 3.94, 95% CI: 1.47-10.56, P = 0.01), a CTO in a non-IRA(OR = 5.09, 95% CI: 1.79 ~ 14.54, P < 0.01), an in-hospital Killip class ≥ 3 (OR = 4.32, 95% CI: 1.71 ~ 10.95, P < 0.01), and the presence of renal insufficiency (OR = 5.32, 95% CI: 1.49 ~ 19.01, P = 0.01), stress ulcer with gastraintestinal bleeding (SUB) (OR = 6.36, 95% CI: (1.45 ~ 28.01, P = 0.01) were significantly related the 10-year mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 (OR = 2.97,95% CI:1.46 ~ 6.03, P < 0.01) and the presence of renal insufficiency (OR = 5.61, 95% CI: 1.19 ~ 26.39, P = 0.03) were significantly related to the 10-year mortality of patients with STEMI and a CTO.
The presence of a CTO in a non-IRA, an age ≥ 65 years, an in-hospital Killip class ≥ 3, and the presence of renal insufficiency, and SUB were independent risk predictors for the long-term mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 and renal insufficiency were independent risk predictors for the long-term mortality of patients with STEMI and a CTO.
探讨非梗死相关动脉（IRA）内存在慢性完全闭塞（CTO）的急性 ST 段抬高型心肌梗死（STEMI）患者的长期预后及死亡的危险因素。
入选 2008 年 1 月至 2013 年 11 月期间接受直接经皮冠状动脉介入治疗的 323 例多支血管病变（MVD）合并 STEMI 患者，根据是否合并 CTO 将患者分为 CTO 组（n=97）和非 CTO 组（n=236）。比较两组患者的长期主要不良心脑血管事件（MACCE）。
CTO 组全因死亡率和 MACCE 发生率均明显高于非 CTO 组。Cox 回归分析显示，年龄≥65 岁（OR=3.94，95%CI：1.4710.56，P=0.01）、非 IRA 内 CTO（OR=5.09，95%CI：1.7914.54，P<0.01）、院内 Killip 分级≥3 级（OR=4.32，95%CI：1.7110.95，P<0.01）、合并肾功能不全（OR=5.32，95%CI：1.4919.01，P=0.01）和应激性溃疡伴胃肠道出血（SUB）（OR=6.36，95%CI：1.4528.01，P=0.01）是 STEMI 合并 MVD 患者 10 年死亡的独立危险因素；院内 Killip 分级≥3 级（OR=2.97，95%CI：1.466.03，P<0.01）和合并肾功能不全（OR=5.61，95%CI：1.19~26.39，P=0.03）是 STEMI 合并 CTO 患者 10 年死亡的独立危险因素。
非 IRA 内 CTO、年龄≥65 岁、院内 Killip 分级≥3 级、合并肾功能不全和 SUB 是 STEMI 合并 MVD 患者长期死亡的独立危险因素；院内 Killip 分级≥3 级和肾功能不全是 STEMI 合并 CTO 患者长期死亡的独立危险因素。
