Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Department of Cardiology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
PLoS One. 2023 Mar 30;18(3):e0276711. doi: 10.1371/journal.pone.0276711. eCollection 2023.
We evaluated the clinical impact of residual non-culprit left main coronary artery disease (LMCAD) on prognosis in patients undergoing emergent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).
A total of 429 patients who underwent PCI for AMI complicated by CS was enrolled from 12 centers in the Republic of Korea. The patients were divided into two groups according to presence of non-culprit LMCAD or not: the LMCAD non-culprit group (n = 43) and the no LMCAD group (n = 386). Primary outcome was major adverse cardiac event (MACE, defined as a composite of cardiac death, myocardial infarction, or repeat revascularization). Propensity score matching analysis was performed to reduce selection bias and potential confounding factors.
During a 12-month follow-up, a total of 168 MACEs occurred (LMCAD non-culprit group, 17 [39.5%] vs. no LMCAD group, 151 [39.1%]). Multivariate analysis revealed no significant difference in the incidence of MACE at 12 months between the LMCAD non-culprit and no LMCAD groups (adjusted hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.58 to 1.62, p = 0.901). After propensity score matching, the incidence of MACE was still similar between the two groups (HR 0.64; 95% CI 0.33 to 1.23; p = 0.180). The similarity of MACEs between the two groups was consistent across a variety of subgroups.
After adjusting for baseline differences, residual non-culprit LMCAD does not appear to increase the risk of MACEs at 12 months in patients undergoing emergent PCI for AMI complicated by CS.
我们评估了在因心原性休克（CS）并发急性心肌梗死（AMI）而行紧急经皮冠状动脉介入治疗（PCI）的患者中，残余非罪犯左主干冠状动脉疾病（LMCAD）对预后的临床影响。
共纳入来自韩国 12 个中心的 429 例因 CS 并发 AMI 而行 PCI 的患者。根据是否存在非罪犯 LMCAD 将患者分为两组：LMCAD 非罪犯组（n = 43）和无 LMCAD 组（n = 386）。主要终点是主要不良心脏事件（MACE，定义为心脏死亡、心肌梗死或再次血运重建的复合事件）。进行倾向评分匹配分析以减少选择偏倚和潜在混杂因素。
在 12 个月的随访期间，共发生 168 例 MACE（LMCAD 非罪犯组 17 例[39.5%] vs. 无 LMCAD 组 151 例[39.1%]）。多变量分析显示，LMCAD 非罪犯组和无 LMCAD 组在 12 个月时 MACE 的发生率无显著差异（校正后的危险比[HR]0.97，95%置信区间[CI]0.58 至 1.62，p = 0.901）。进行倾向评分匹配后，两组间 MACE 的发生率仍相似（HR 0.64；95% CI 0.33 至 1.23；p = 0.180）。两组间 MACE 的相似性在各种亚组中均一致。
在调整基线差异后，残余非罪犯 LMCAD 似乎不会增加因 CS 并发 AMI 而行紧急 PCI 的患者在 12 个月时发生 MACE 的风险。
