Nishihira Kensaku, Kojima Sunao, Takegami Misa, Honda Satoshi, Nakao Yoko M, Takahashi Jun, Itoh Tomonori, Watanabe Tetsu, Takayama Morimasa, Shimokawa Hiroaki, Sumiyoshi Tetsuya, Kimura Kazuo, Yasuda Satoshi
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan.
Department of General Internal Medicine 3, Kawasaki Medical School Kurashiki Japan.
Circ Rep. 2019 Nov 29;1(12):601-609. doi: 10.1253/circrep.CR-19-0056.
Acute coronary syndrome (ACS) due to an unprotected left main coronary artery (LMCA) lesion is a critical condition, but there are limited data available on in-hospital outcomes of percutaneous coronary intervention (PCI). The Japan Acute Myocardial Infarction Registry is a nationwide, real-world database. The clinical data on 13,548 ACS patients hospitalized between January 2011 and December 2013 were retrospectively collected from 10 representative regional ACS registry groups. We compared the 404 patients (3.0%) with LMCA ACS with the remaining 13,144 patients with non-LMCA ACS. The LMCA group was characterized by older age, lower rate of ST-segment elevation myocardial infarction, and higher rate of advanced Killip class. In-hospital mortality was significantly higher in patients with LMCA ACS than in those with non-LMCA ACS (23.3% vs. 5.5%, respectively; P<0.001). Primary PCI for non-LMCA lesions was associated with lower in-hospital mortality (OR, 0.48; 95% CI: 0.34-0.66), but that for LMCA lesions was not (OR, 2.89; 95% CI: 1.13-7.40). Longer door-to-balloon time was associated with Killip class ≥2 and higher in-hospital mortality in the non-LMCA group but not in the LMCA group. Primary PCI in patients with LMCA ACS is still challenging; therefore, effective strategies are needed.
由无保护左主干冠状动脉（LMCA）病变导致的急性冠状动脉综合征（ACS）是一种危急情况，但关于经皮冠状动脉介入治疗（PCI）的院内结局的可用数据有限。日本急性心肌梗死登记系统是一个全国性的真实世界数据库。我们从10个具有代表性的地区ACS登记组中回顾性收集了2011年1月至2013年12月期间住院的13548例ACS患者的临床数据。我们将404例（3.0%）LMCA ACS患者与其余13144例非LMCA ACS患者进行了比较。LMCA组的特点是年龄较大、ST段抬高型心肌梗死发生率较低以及高级Killip分级发生率较高。LMCA ACS患者的院内死亡率显著高于非LMCA ACS患者（分别为23.3%和5.5%；P<0.001）。非LMCA病变的直接PCI与较低的院内死亡率相关（OR，0.48；95%CI：0.34 - 0.66），但LMCA病变的直接PCI并非如此（OR，2.89；95%CI：1.13 - 7.40）。在非LMCA组中，较长的门球时间与Killip分级≥2及较高的院内死亡率相关，但在LMCA组中并非如此。LMCA ACS患者的直接PCI仍然具有挑战性；因此，需要有效的策略。
