中文人群中孤立性左心室和右心室心肌梗死的临床特征和预后差异：一项回顾性研究。

Clinical characteristics and prognosis differences between isolated right and left ventricular myocardial infarction in the Chinese population: a retrospective study.

机构信息

Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.

Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China.

出版信息

PeerJ. 2023 Feb 28;11:e14959. doi: 10.7717/peerj.14959. eCollection 2023.

DOI:10.7717/peerj.14959

PMID:36874976

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9983429/

Abstract

BACKGROUND AND AIMS

Acute myocardial infarction (AMI) is divided into left ventricular myocardial infarction (LVMI) and right ventricular myocardial infarction (RVMI) according to the regions of myocardial ischemic necrosis. Clinical characteristics, treatment strategies, and prognosis differences between isolated RVMI and LVMI have not been well characterized. This study aimed to explore this difference of patients with isolated RVMI and LVMI.

METHODS

This retrospective cohort study included 3,506 patients hospitalized with coronary angiography diagnosed type 1 myocardial infarction (MI). Characteristics of admission and treatment strategies were compared in patients with isolated RVMI and LVMI. COX proportional hazards models with and without inverse probability of treatment weighting (IPTW) adjustment were performed to estimate the difference in all-cause and cardiovascular mortality between the two groups.

RESULTS

In this retrospective study, we found the frequency of isolated RVMI was significantly lower in the population than that of isolated LVMI (406 (11.6%) 3,100 (88.4%)). Patients with isolated RVMI have similar age, sex, and comorbidities to the patients with isolated LVMI. However, patients with isolated RVMI have lower heart rate and blood pressure, but higher rates of cardiogenic shock and atrioventricular block. It is noteworthy that patients with isolated RVMI are more likely to be complicated with the multivessel lesion. Patients with isolated RVMI have lower risk of all-cause mortality (HR 0.36; 95% CI [0.24-0.54], < 0.001) and cardiovascular mortality (HR 0.37; 95% CI [0.22-0.62], < 0.001) than patients with isolated LVMI.

CONCLUSIONS

This study showed that patients with isolated RVMI and LVMI have similar baseline characteristics. However, the clinical manifestations were different in the isolated RVMI and LVMI patients. This study revealed a better prognosis of isolated RVMI patients compared to isolated LVMI, which indicates the ischemic region could be considered in AMI risk stratification models for better assessment of risk for adverse clinical events.

摘要

背景与目的

急性心肌梗死（AMI）根据心肌缺血性坏死区域分为左心室心肌梗死（LVMI）和右心室心肌梗死（RVMI）。孤立性 RVMI 和 LVMI 患者的临床特征、治疗策略和预后差异尚未得到很好的描述。本研究旨在探讨孤立性 RVMI 和 LVMI 患者的这一差异。

方法

这项回顾性队列研究纳入了 3506 例因冠状动脉造影诊断为 1 型心肌梗死（MI）住院的患者。比较孤立性 RVMI 和 LVMI 患者入院时的特征和治疗策略。分别采用 COX 比例风险模型和不考虑倾向评分匹配（IPTW）调整模型来估计两组之间全因和心血管死亡率的差异。

结果

在这项回顾性研究中，我们发现孤立性 RVMI 的发生率明显低于孤立性 LVMI（406[11.6%]比 3100[88.4%]）。孤立性 RVMI 患者的年龄、性别和合并症与孤立性 LVMI 患者相似。然而，孤立性 RVMI 患者的心率和血压较低，但心源性休克和房室传导阻滞的发生率较高。值得注意的是，孤立性 RVMI 患者更容易合并多支血管病变。与孤立性 LVMI 患者相比，孤立性 RVMI 患者的全因死亡率（HR 0.36；95%CI [0.24-0.54]，<0.001）和心血管死亡率（HR 0.37；95%CI [0.22-0.62]，<0.001）较低。