中国右心室梗死患者基于再灌注策略方式的短期和长期结局：来自中国急性心肌梗死注册研究的数据
Short- and Long-Term Outcomes in Patients With Right Ventricular Infarction According to Modalities of Reperfusion Strategies in China: Data From China Acute Myocardial Infarction Registry.
作者信息
Hu Mengjin, Chen Ge, Yang Hongmei, Gao Xiaojin, Yang Jingang, Xu Haiyan, Wu Yuan, Song Lei, Qiao Shubin, Hu Fenghuan, Wang Yang, Li Wei, Jin Chen, Yang Yuejin
机构信息
State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
First Hospital of Qinhuangdao, Qinhuangdao, China.
出版信息
Front Cardiovasc Med. 2022 Feb 10;9:741110. doi: 10.3389/fcvm.2022.741110. eCollection 2022.
PURPOSE
We sought to investigate the short- and long-term outcomes in patients with right ventricular infarction in China.
METHODS
Data from China Acute Myocardial Infarction (CAMI) Registry for patients with right ventricular infarction between January 2013 and September 2014 were analyzed.
RESULTS
Of the 1,988 patients with right ventricular infarction, 733 patients did not receive reperfusion therapy, 281 patients received thrombolysis therapy, and 974 patients underwent primary PCI. Primary PCI and thrombolysis were all associated with lower risks of in-hospital (3.1 vs. 12.6%; adjusted OR: 0.48; 95% CI: 0.27-0.87; = 0.0151 and 5.7 vs. 12.6%; adjusted OR: 0.43; 95% CI: 0.22-0.85; = 0.0155, respectively), and 2-year all-cause mortality (6.3 vs. 20.9%; adjusted HR: 0.50; 95% CI: 0.34-0.73; = 0.0003 and 11.0 vs. 20.9%; adjusted HR: 0.59; 95% CI: 0.38-0.92; = 0.0189, respectively), compared with no reperfusion therapy. Meanwhile, primary PCI was superior to thrombolysis in reducing the risks of in-hospital atrial-ventricular block (4.2 vs. 8.9%; adjusted OR: 0.46; 95% CI: 0.23-0.91; = 0.0257), cardiogenic shock (5.3 vs. 13.9%; adjusted OR: 0.43; 95% CI: 0.23-0.83; = 0.0115), and heart failure (8.5 vs. 23.5%; adjusted OR: 0.35; 95% CI: 0.22-0.56; < 0.0001). Primary PCI could reduce the risk of 2-year major adverse cardiac and cerebrovascular event (19.1 vs. 33.3%; adjusted HR: 0.72; 95% CI: 0.56-0.92; = 0.0092) relative to no reperfusion therapy, whereas thrombolysis may increase the risk of 2-year revascularization (15.5 vs. 8.7%; adjusted HR: 1.90; 95% CI: 1.15-3.16; = 0.0124) compared with no reperfusion therapy.
CONCLUSIONS
Timely reperfusion therapy is essential for patients with right ventricular infarction. Primary PCI may be considered as the default treatment strategy for patients with right ventricular infarction in the contemporary primary PCI era.
目的
我们旨在调查中国右心室梗死患者的短期和长期预后。
方法
分析了中国急性心肌梗死（CAMI）注册研究中2013年1月至2014年9月期间右心室梗死患者的数据。
结果
在1988例右心室梗死患者中，733例患者未接受再灌注治疗，281例患者接受了溶栓治疗，974例患者接受了直接经皮冠状动脉介入治疗（PCI）。与未进行再灌注治疗相比，直接PCI和溶栓治疗均与较低的院内风险相关（分别为3.1%对12.6%；校正比值比：0.48；95%置信区间：0.27 - 0.87；P = 0.0151和5.7%对12.6%；校正比值比：0.43；95%置信区间：0.22 - 0.85；P = 0.0155），以及2年全因死亡率（分别为6.3%对20.9%；校正风险比：0.50；95%置信区间：0.34 - 0.73；P = 0.0003和11.0%对20.9%；校正风险比：0.59；95%置信区间：0.38 - 0.92；P = 0.0189）。同时，在降低院内房室传导阻滞风险（4.2%对8.9%；校正比值比：0.46；95%置信区间：0.23 - 0.91；P = 0.025）、心源性休克风险（5.3%对13.9%；校正比值比：0.43；95%置信区间：0.23 - 0.83；P = 0.0115）和心力衰竭风险（8.5%对23.5%；校正比值比：0.35；95%置信区间：0.22 - 0.56；P < 0.0001）方面，直接PCI优于溶栓治疗。与未进行再灌注治疗相比，直接PCI可降低2年主要不良心脑血管事件风险（19.1%对33.3%；校正风险比：0.72；95%置信区间：0.56 - 0.92；P = 0.0092），而与未进行再灌注治疗相比，溶栓治疗可能增加2年血运重建风险（15.5%对8.7%；校正风险比：1.90；95%置信区间：1.15 - 3.16；P = 0.0124）。
结论
对于右心室梗死患者，及时的再灌注治疗至关重要。在当代直接PCI时代，直接PCI可被视为右心室梗死患者的默认治疗策略。
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