Department of Cardiology, Centro Hospitalar Universitário de Santo António (CHUdSA), Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal.
ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal.
ESC Heart Fail. 2024 Aug;11(4):1981-1994. doi: 10.1002/ehf2.14683. Epub 2024 Mar 28.
Acute myocardial infarction (AMI) resulting from unprotected left main coronary artery (LMCA) occlusion and subtotal occlusion is a life-threatening condition. Although AMI management has improved in the past two decades, there is limited information on recent trends in patient characteristics, management, and outcomes for acute unprotected LMCA-related AMI. This study aims to assess such trends over a 12 year period.
This retrospective multicentre study includes patients with unprotected LMCA occlusion/subtotal occlusion admitted to three tertiary hospitals between 2008 and 2020. The patients were divided into two groups based on the chronology of presentation: a 'past group' (January 2008 to December 2014) and a 'contemporary group' (January 2015 to December 2020). The study compares clinical characteristics, management approaches, and outcomes between the two groups. The study includes 128 patients, with 51 (40%) in the 'past group' and 77 (60%) in the 'contemporary group'. Baseline risk factors did not show statistically significant differences between the two groups, except for hypertension (49% vs. 74%; P = 0.005). Chest pain was more frequent in the 'past group' (98% vs. 89%; P = 0.014), and a trend towards more cardiac arrests was observed in the 'contemporary group' (18% vs. 31%; P = 0.087). Revascularization type did not differ significantly (P = 0.419), but manual thrombectomy was less frequently used (41% vs. 23%; P = 0.032) and stent implantation showed a trend towards higher rates (66% vs. 78%; P = 0.150) in the 'contemporary cohort'. There was a gradual shift from bare-metal to drug-eluting stents, with a significantly higher percentage of ticagrelor/prasugrel loading in the 'contemporary cohort' (5% vs. 79%; P < 0.001). The use of mechanical circulatory support (MCS), although not statistically significant, was higher among patients in the 'past group' (67% vs. 51%; P = 0.073). The type of MCS differed significantly between groups, with a decrease in intra-aortic balloon pump use (67% vs. 42%; P = 0.005) and an increase in veno-arterial extracorporeal membrane oxygenation (4% vs. 22%; P = 0.005) and Impella system (0% vs. 3%) over time. Survival analysis showed no significant differences (P = 0.599; log-rank test) in all-cause mortality between the different time groups, with the long-term survival rate being approximately 30%.
In our real-world population, despite the progressive use of newer drugs and more advanced devices over time, patients with unprotected LMCA occlusion/subtotal occlusion remain a subpopulation with poor prognosis.
未保护的左主干冠状动脉（LMCA）闭塞和次全闭塞导致的急性心肌梗死（AMI）是一种危及生命的情况。尽管在过去的二十年中 AMI 管理得到了改善，但关于急性未保护的 LMCA 相关 AMI 的患者特征、管理和结局的最新趋势的信息有限。本研究旨在评估 12 年来的此类趋势。
本回顾性多中心研究纳入了 2008 年至 2020 年期间在三家三级医院因未保护的 LMCA 闭塞/次全闭塞住院的患者。根据就诊时间的先后顺序，患者被分为两组：“过去组”（2008 年 1 月至 2014 年 12 月）和“当代组”（2015 年 1 月至 2020 年 12 月）。本研究比较了两组之间的临床特征、治疗方法和结局。研究纳入了 128 例患者，其中“过去组”51 例（40%），“当代组”77 例（60%）。两组间的基线风险因素除高血压（49%比 74%；P=0.005）外，无统计学差异。“过去组”胸痛更常见（98%比 89%；P=0.014），“当代组”观察到心脏骤停的趋势更高（18%比 31%；P=0.087）。血运重建类型无显著差异（P=0.419），但手动血栓切除术的应用频率较低（41%比 23%；P=0.032），支架植入的比例呈上升趋势（66%比 78%；P=0.150）。从裸金属支架到药物洗脱支架的转变逐渐发生，“当代组”替格瑞洛/普拉格雷负荷的比例显著升高（5%比 79%；P<0.001）。尽管没有统计学意义，但“过去组”患者中机械循环支持（MCS）的使用比例更高（67%比 51%；P=0.073）。两组之间 MCS 的类型存在显著差异，主动脉内球囊泵的使用比例下降（67%比 42%；P=0.005），静脉-动脉体外膜肺氧合（4%比 22%；P=0.005）和 Impella 系统（0%比 3%）的使用比例上升。生存分析显示不同时间组之间全因死亡率无显著差异（P=0.599；对数秩检验），长期生存率约为 30%。
在我们的真实世界人群中，尽管随着时间的推移，越来越多地使用新型药物和更先进的设备，但未保护的 LMCA 闭塞/次全闭塞患者仍然是预后较差的亚群。
