Wang T J, Dong J L, Yan S, Chen G H, Chen G, Zhao Y Y, Qian H Y, Yuan J S, Song L, Qiao S B, Yang J G, Yang W X, Yang Yuejin
Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases,Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China.
Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China.
Zhonghua Nei Ke Za Zhi. 2022 Apr 1;61(4):384-389. doi: 10.3760/cma.j.cn112138-20210626-00445.
To investigate the clinical impacts of chronic total occlusion (CTO) in acute non-ST segment elevation myocardial infarction (NSTEMI) patients underwent primary percutaneous coronary intervention (PCI). A total of 2 271 acute NSTEMI patients underwent primary PCI from China Acute Myocardial Infarction Registry were enrolled in this study and divided into the CTO group and the non-CTO group according to the angiography. The primary endpoint was in-hospital mortality and mortality during a 2-year follow-up. The secondary endpoint was major adverse cardiovascular events (MACE) including revascularization, death, re-myocardial infarction, heart failure readmission, stroke and major bleeding. Thirteen-point four percent of the total acute NSTEMI patients had concurrent CTO. In-hospital mortality (3.6% vs. 1.4%, P<0.01) and 2-year mortality (9.0% vs. 5.1%, <0.01) were significantly higher in the CTO group than those in the non-CTO group, respectively. Multiple regression analyses showed that chronic obstructive pulmonary disease ( 7.28, 95% 1.50-35.35, =0.01) was an independent risk factor of in-hospital mortality, and advanced age ( 1.04, 95% 1.01-1.07, <0.01), and low levels of ejection fraction ( 0.95, 95% 0.93-0.98, <0.01) were independent risk factors of 2-year mortality. CTO (1.67, 95% 1.10-2.54, =0.02) was an independent risk factor of revascularization, but not a risk factor of mortality. Although acute NSTEMI patients concurrent with CTO had higher mortality, CTO was only an independent risk factor of revascularization, but not of mortality. Advanced age and low levels of ejection fraction were independent risk factors of long-term death among acute NSTEMI patients.
为研究慢性完全闭塞病变（CTO）对接受直接经皮冠状动脉介入治疗（PCI）的急性非ST段抬高型心肌梗死（NSTEMI）患者的临床影响。本研究纳入了中国急性心肌梗死注册研究中2271例行直接PCI的急性NSTEMI患者，并根据血管造影结果分为CTO组和非CTO组。主要终点为住院死亡率和2年随访期内的死亡率。次要终点为主要不良心血管事件（MACE），包括血运重建、死亡、再发心肌梗死、心力衰竭再入院、中风和大出血。所有急性NSTEMI患者中13.4%合并CTO。CTO组的住院死亡率（3.6% 对1.4%，P<0.01）和2年死亡率（9.0% 对5.1%，P<0.01）分别显著高于非CTO组。多因素回归分析显示，慢性阻塞性肺疾病（比值比7.28，95%置信区间1.50 - 35.35，P = 0.01）是住院死亡率的独立危险因素，高龄（比值比1.04，95%置信区间1.01 - 1.07，P<0.01）和低射血分数（比值比0.95，95%置信区间0.93 - 0.98，P<0.01）是2年死亡率的独立危险因素。CTO（比值比1.67，95%置信区间1.10 - 2.54，P = 0.02）是血运重建的独立危险因素，但不是死亡的危险因素。虽然合并CTO的急性NSTEMI患者死亡率较高，但CTO仅是血运重建的独立危险因素，而非死亡的危险因素。高龄和低射血分数是急性NSTEMI患者长期死亡的独立危险因素。
