Mikaeilvand Amir, Firuozi Ata, Basiri Hosseinali, Varghaei Aida, Izadpanah Peyman, Kojuri Javad, Abdi-Ardekani Alireza, Attar Armin
Department of Cardiology, Urmia University of Medical Sciences, Urmia, Iran.
Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Res Med Sci. 2020 Nov 26;25:107. doi: 10.4103/jrms.JRMS_414_19. eCollection 2020.
Percutaneous coronary intervention (PCI) is the treatment of choice for patients with ST-segment elevation myocardial infarction (STEMI). Effect of coronary artery dominance on the patients' outcome following primary PCI (PPCI) is not fully investigated. We investigated the association of coronary artery dominance with complications and 1-year mortality rate of PPCI.
In this retrospective study, patients with STEMI treated with PPCI from March 2016 to February 2018 were divided into three groups based on their coronary dominancy: left dominance (LD), right dominance (RD), and codominant. Demographic characteristics, medical history, results of physical examination, electrocardiography, angiography, and echocardiography were compared between the groups.
Of 491 patients included in this study, 34 patients (7%) were LD and 22 patients (4.5%) were codominant. Accordingly, 54 propensity-matched RD patients were included in the analysis. The demographics and comorbidities of the three groups were not different ( > 0.05); however, all patients in the RD group had thrombolysis in myocardial infarction (TIMI) 3, while five patients in the LD and five patients in the codominant group had a TIMI ≤2 ( = 0.006). At admission, the median left ventricular ejection fraction (LVEF) was highest in RD patients and lowest in LD and codominant patients (34%, = 0.009). There was no difference in terms of success or complications of PCI, in-hospital, and 1-year mortality rate ( > 0.05).
Patients with left coronary artery dominance had a higher value of indicators of worse outcomes, such as lower LVEF and TIMI ≤ 2, compared with RD patients, but not different rates of success or complications of PCI, in-hospital, and 1-year mortality. This finding may suggest that interventionists should prepare themselves with protective measures for no-reflow and slow-flow phenomenon and also mechanical circulatory support before performing PPCI in LD patients.
经皮冠状动脉介入治疗（PCI）是ST段抬高型心肌梗死（STEMI）患者的首选治疗方法。冠状动脉优势对直接PCI（PPCI）后患者预后的影响尚未得到充分研究。我们调查了冠状动脉优势与PPCI并发症及1年死亡率之间的关联。
在这项回顾性研究中，2016年3月至2018年2月接受PPCI治疗的STEMI患者根据冠状动脉优势分为三组：左优势型（LD）、右优势型（RD）和共优势型。比较三组患者的人口统计学特征、病史、体格检查结果、心电图、血管造影和超声心动图结果。
本研究纳入的491例患者中，34例（7%）为LD型，22例（4.5%）为共优势型。相应地，54例倾向匹配的RD患者纳入分析。三组患者的人口统计学和合并症无差异（>0.05）；然而，RD组所有患者的心肌梗死溶栓（TIMI）血流分级为3级，而LD组和共优势型组各有5例患者的TIMI血流分级≤2级（P = 0.006）。入院时，RD患者的左心室射血分数（LVEF）中位数最高，LD和共优势型患者最低（34%，P = 0.009）。PCI的成功率或并发症、住院期间及1年死亡率方面无差异（>0.05）。
与RD患者相比，左冠状动脉优势型患者的预后指标值更高，如LVEF较低和TIMI血流分级≤2级，但PCI的成功率或并发症、住院期间及1年死亡率无差异。这一发现可能提示介入医生在对LD患者进行PPCI之前，应针对无复流和慢血流现象以及机械循环支持做好保护措施准备。
