Tianjin Medical Universityy, Tianjin, China.
Department of Cardiology, Tianjin Chest Hospital, Jizhao Road, Jinnan District, Tianjin, 300051, China.
BMC Cardiovasc Disord. 2022 Apr 2;22(1):144. doi: 10.1186/s12872-022-02585-x.
Data on the clinical characteristics, electrocardiogram (ECG) findings and outcomes of patients with acute myocardial infarction (AMI) due to total unprotected left main (ULM) artery occlusion is limited.
Between 2009 and 2021, 44 patients with AMI due to total ULM occlusion underwent primary percutaneous coronary intervention (PCI) at our institution. The ECG, collateral circulation, clinical and procedural characteristics, and in-hospital mortality were retrospectively evaluated.
Twenty five patients presented with shock and 18 patients had in-hospital mortality. Nineteen patients presented with ST-segment elevation myocardial infarction (STEMI), while 25 presented with non-ST-segment elevation myocardial infarction (NSTEMI). ST-segment elevation (STE) in I and STEMI were associated with the absence of collateral circulation, while STE in aVR was associated with its presence. In the NSTEMI group, patients with STE in both aVR and aVL showed more collateral filling of the left anterior descending coronary artery (LAD) territory, while patients with STE in aVR showed more collateral filling of the LAD and the left circumflex artery territory. Compared with total ULM occlusion, patients with partial ULM obstruction presented with more STE in aVR, less STE in aVR and aVL, and less STEMI. Shock, post-PCI TIMI 0-2 flow, non-STE in aVR, STEMI, and STE in I predicted in-hospital mortality. STEMI and the absence of collateral flow were significantly associated with shock.
STE in the precordial leads predicted the absence of collateral circulation while STE in aVR and STE in both aVR and aVL predicted different collateral filling territories in ULM occlusion. STE in I, non-STE in aVR, and STEMI predicted in-hospital mortality in these patients.
关于完全无保护左主干（ULM）动脉闭塞导致的急性心肌梗死（AMI）患者的临床特征、心电图（ECG）表现和结局的数据有限。
在 2009 年至 2021 年期间，我院对 44 例完全 ULM 闭塞导致的 AMI 患者进行了经皮冠状动脉介入治疗（PCI）。回顾性评估了心电图、侧支循环、临床和手术特征以及院内死亡率。
25 例患者出现休克，18 例患者院内死亡。19 例患者表现为 ST 段抬高型心肌梗死（STEMI），而 25 例患者表现为非 ST 段抬高型心肌梗死（NSTEMI）。I 导联和 STEMI 的 ST 段抬高（STE）与侧支循环缺失相关，而 aVR 导联的 STE 与侧支循环存在相关。在 NSTEMI 组中，STE 同时存在于 aVR 和 aVL 的患者显示出左前降支（LAD）区域更多的侧支充盈，而 STE 仅存在于 aVR 的患者显示出 LAD 和左旋支区域更多的侧支充盈。与完全 ULM 闭塞相比，部分 ULM 阻塞患者的 aVR 导联 STE 更多，aVR 和 aVL 导联 STE 更少，STEMI 更少。休克、PCI 后 TIMI 血流 0-2 级、aVR 导联非 STE、STEMI 和 I 导联 STE 预测院内死亡率。STE 和侧支循环缺失与休克显著相关。
胸前导联 STE 预测侧支循环缺失，而 aVR 导联 STE 和 aVR 和 aVL 导联 STE 预测 ULM 闭塞不同的侧支充盈区域。I 导联 STE、aVR 导联非 STE 和 STEMI 预测这些患者的院内死亡率。
