Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Am J Cardiol. 2022 May 1;170:17-24. doi: 10.1016/j.amjcard.2022.01.021. Epub 2022 Feb 19.
Patients with acute myocardial infarction (AMI) with chronic total occlusion (CTO) in nonculprit arteries had worse prognosis than patients with AMI without CTO in nonculprit arteries. However, the reason was not clearly explained. This retrospective study aimed to compare the clinical outcomes between patients with AMI with CTO versus those with severe stenosis (90% to 99% stenosis) in nonculprit arteries, which would help to elucidate the role of CTO in nonculprit arteries. We included 643 patients with AMI and divided those into the CTO group (n = 188) and 90% to 99% stenosis group (n = 455). The primary end point was the major adverse cardiovascular events (MACE) defined as the composite of all-cause death, nonfatal myocardial infarction, and readmission for heart failure. During the median follow-up duration of 431 days (Q1:178 days to Q3:950 days), a total of 189 MACE was observed. The Kaplan-Meier curves showed that MACE was more frequently observed in the CTO group than in the 90% to 99% stenosis group (p <0.001). The multivariate Cox hazard analysis revealed that CTO in nonculprit arteries (vs 90% to 99% stenosis) was significantly associated with MACE (hazard ratio 1.410, 95% confidence interval 1.042 to 1.907; p = 0.026) after controlling known confounding factors. In conclusion, patients with AMI with CTO in nonculprit arteries had worse clinical outcomes than those with 90% to 99% stenosis in nonculprit arteries. Patients with AMI with CTO could be recognized as a high-risk group rather than those with 90% to 99% stenosis and should be carefully managed to prevent cardiovascular events.
急性心肌梗死（AMI）合并非罪犯动脉慢性完全闭塞（CTO）的患者预后较非罪犯动脉无 CTO 的 AMI 患者差，但具体原因尚未阐明。本回顾性研究旨在比较 AMI 合并 CTO 与非罪犯动脉严重狭窄（90%99%狭窄）患者的临床结局，以明确 CTO 在非罪犯动脉中的作用。共纳入 643 例 AMI 患者，分为 CTO 组（n=188）和 90%99%狭窄组（n=455）。主要终点为全因死亡、非致死性心肌梗死和心力衰竭再住院的复合主要不良心血管事件（MACE）。在中位数为 431 天（Q1：178 天，Q3：950 天）的随访期间，共观察到 189 例 MACE。Kaplan-Meier 曲线显示，CTO 组 MACE 发生率高于 90%99%狭窄组（p<0.001）。多变量 Cox 风险分析显示，在控制已知混杂因素后，非罪犯动脉 CTO（与 90%99%狭窄相比）与 MACE 显著相关（危险比 1.410，95%置信区间 1.0421.907；p=0.026）。总之，非罪犯动脉 CTO 的 AMI 患者临床结局较非罪犯动脉 90%99%狭窄的 AMI 患者差。非罪犯动脉 CTO 的 AMI 患者可视为高危人群，而非 90%~99%狭窄的 AMI 患者，应谨慎管理以预防心血管事件。
