Shibata Naoki, Umemoto Norio, Tanaka Akihito, Takagi Kensuke, Iwama Makoto, Uemura Yusuke, Inoue Yosuke, Negishi Yosuke, Ohashi Taiki, Tanaka Miho, Yoshida Ruka, Shimizu Kiyokazu, Tashiro Hiroshi, Yoshioka Naoki, Morishima Itsuro, Noda Toshiyuki, Watarai Masato, Asano Hiroshi, Tanaka Toshikazu, Tatami Yosuke, Takada Yasunobu, Ishii Hideki, Murohara Toyoaki
Department of Cardiology, Ichinomiya Municipal Hospital.
Department of Cardiology, Nagoya University Graduate School of Medicine.
Circ J. 2021 Sep 24;85(10):1789-1796. doi: 10.1253/circj.CJ-20-0545. Epub 2021 Mar 20.
Data regarding the clinical features, outcomes and prognostic factors in patients presenting with acute total/subtotal occlusion of the unprotected left main coronary artery (LMCA) remain limited.
From a multi-center registry, 134 patients due to acute total/subtotal occlusion of the unprotected LMCA were reviewed. Emergency room (ER) status classification was defined according to the presence of cardiogenic shock and cardiopulmonary arrest (CPA) in the ER (class 1=no cardiogenic shock; class 2= cardiogenic shock but not CPA; and class 3=CPA). In-hospital mortality and cerebral performance category (CPC) as the endpoints were evaluated. One-half (67/134) of the enrolled patients presented with total occlusion of the unprotected LMCA. Regarding ER status classification, class 1, 2, and 3 were observed in 30.6%, 45.5%, and 23.9% of the patients, respectively. In-hospital mortality occurred in 73 (54.5%) patients; of the remaining patients, 52 (85.3%) could be discharged with a CPC 1 or 2. ER status classification (odds ratio 4.4 [95% confidence interval: 2.33-10.67]; P<0.001) and total occlusion of the unprotected LMCA (odds ratio 8.29 [95% confidence interval 2.93-23.46]; P<0.001) were strong predictors of in-hospital mortality.
Acute total/subtotal occlusion involving the unprotected LMCA appeared to be associated with high in-hospital mortality. ER status classification and initial flow in the unprotected LMCA were significant predictive factors of in-hospital mortality.
关于无保护左主干冠状动脉（LMCA）急性完全/次全闭塞患者的临床特征、预后及预后因素的数据仍然有限。
从一个多中心注册研究中，对134例因无保护LMCA急性完全/次全闭塞的患者进行了回顾性分析。根据急诊室（ER）中心源性休克和心肺骤停（CPA）的情况对急诊室状态进行分类（1级=无心源性休克；2级=有心源性休克但无CPA；3级=CPA）。以住院死亡率和脑功能分类（CPC）作为终点进行评估。入组患者中有一半（67/134）表现为无保护LMCA完全闭塞。关于急诊室状态分类，1级、2级和3级分别在30.6%、45.5%和23.9%的患者中观察到。73例（54.5%）患者发生了住院死亡；其余患者中，52例（85.3%）可出院时CPC为1或2级。急诊室状态分类（优势比4.4[95%置信区间：2.33 - 10.67]；P<0.001）和无保护LMCA完全闭塞（优势比8.29[95%置信区间2.93 - 23.46]；P<0.001）是住院死亡率的强预测因素。
涉及无保护LMCA的急性完全/次全闭塞似乎与高住院死亡率相关。急诊室状态分类和无保护LMCA的初始血流是住院死亡率的重要预测因素。
