The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
The Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
J Cardiol. 2021 Nov;78(5):463-470. doi: 10.1016/j.jjcc.2021.06.005. Epub 2021 Jul 2.
Right ventricular branch compromise (RVBC) following percutaneous coronary intervention (PCI) in patients with acute inferior myocardial infarction (AIMI) is associated with short-term adverse clinical outcomes. Chronic kidney disease (CKD) is also known to be a major risk factor after PCI in AIMI. However, little is known about the impact of RVBC and CKD on long-term prognosis.
From January 2009 to January 2019, we retrospectively enrolled 90 consecutive patients with ST-elevation AIMI who had a culprit lesion in the proximal-to-mid right coronary arteries and underwent PCI in our institution. After the measurement of the Thrombolysis in Myocardial Infarction frame counts in RV branches using post-PCI angiography, we divided them into two groups (RVBC, n = 49; non-RVBC, n = 41), and investigated their long-term prognosis for 43±31 months. The primary endpoint was the incidence of major adverse cardiac events (MACEs), including all-cause death, nonfatal MI, congestive heart failure requiring hospitalization, and life-threatening arrhythmia.
Both groups showed similar clinical characteristics; however, the baseline right ventricular function after PCI was significantly worse in RVBC than in non- RVBC. Twenty-four MACEs occurred during the follow-up (RVBC vs. non-RVBC: 37% vs. 14%, p = 0.002). In the multivariate analysis, both RVBC and baseline CKD were powerful predictors of MACEs (RVBC: hazard ratio [HR] 2.85, CKD: HR 2.29). Baseline CKD showed higher hazard ratios of MACEs in RVBC (CKD: HR 7.19 vs. non-CKD: HR 0.24).
The prognoses of RVBC after primary PCI in patients with AIMI were poor. Baseline CKD and RVBC were associated with poor long-term clinical outcomes.
急性下壁心肌梗死（AIMI）患者经皮冠状动脉介入治疗（PCI）后右心室分支（RVBC）受损与短期不良临床结局相关。慢性肾脏病（CKD）也是 AIMI 患者 PCI 后的主要危险因素。然而，关于 RVBC 和 CKD 对长期预后的影响知之甚少。
本研究回顾性纳入了 2009 年 1 月至 2019 年 1 月期间在我院接受治疗的 90 例 ST 段抬高型 AIMI 患者，这些患者的罪犯病变位于近段至中段右冠状动脉，且接受了 PCI。在使用 PCI 后血管造影术测量 RV 分支中的溶栓治疗心肌梗死帧数后，我们将患者分为两组（RVBC 组，n=49；非 RVBC 组，n=41），并对两组患者进行了 43±31 个月的随访，以评估其长期预后。主要终点是主要不良心脏事件（MACE）的发生率，包括全因死亡、非致死性心肌梗死、需要住院治疗的充血性心力衰竭和危及生命的心律失常。
两组患者的临床特征相似，但 RVBC 组患者 PCI 后右心室功能基线明显更差。随访期间共发生 24 例 MACE（RVBC 组 vs. 非 RVBC 组：37% vs. 14%，p=0.002）。多因素分析显示，RVBC 和基线 CKD 均是 MACE 的强预测因素（RVBC：风险比[HR]2.85，CKD：HR 2.29）。基线 CKD 在 RVBC 患者中与 MACE 发生的相关性更高（CKD：HR 7.19 vs. 非 CKD：HR 0.24）。
AIMI 患者 PCI 后 RVBC 的预后较差。基线 CKD 和 RVBC 与不良的长期临床结局相关。
