Hamaguchi Koudai, Sakakura Kenichi, Jinnouchi Hiroyuki, Taniguchi Yousuke, Yamamoto Kei, Tsukui Takunori, Hatori Masashi, Kasahara Taku, Watanabe Yusuke, Ishibashi Shun, Seguchi Masaru, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan.
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan.
J Cardiol. 2025 Feb;85(2):88-95. doi: 10.1016/j.jjcc.2024.07.007. Epub 2024 Aug 2.
The clinical outcomes of ST-segment elevation myocardial infarction (STEMI) due to the occlusion of left coronary artery are worse in patients with proximal occlusion than in those with non-proximal occlusion. However, there are few reports that focus on the comparison of clinical outcomes in patients with STEMI between proximal and non-proximal right coronary artery (RCA) occlusions.
We included 356 patients with STEMI whose infarct-related artery is RCA and divided them into the proximal group (n = 129) and the non-proximal group (n = 227). We defined segment 1 of RCA as proximal, and segments 2, 3, and 4 as non-proximal according to the reporting system of the American Heart Association. The primary endpoint was major cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, readmission for heart failure, and ischemia-driven target vessel revascularization.
Incidence of shock at admission, requirement for catecholamine during percutaneous coronary intervention (PCI), or mechanical support during PCI tended to be higher in the proximal group (42.6 %) than in the non-proximal group (33.5 %) (p = 0.088). Although the incidence of right ventricular infarction tended to be higher in the proximal group (17.8 %) than in the non-proximal group (10.6 %) without reaching statistical significance (p = 0.072), the incidence of in-hospital death was similar between the 2 groups (1.6 % versus 1.8 %, p = 1.000). The MACE-free survival curves were not different between the 2 groups (p = 0.400). Multivariate Cox hazard analysis revealed that proximal RCA occlusion was not associated with MACE (HR 1.095, 95%CI 0.691-1.737, p = 0.699).
Although the acute phase conditions such as shock or right ventricular infarction tended to be more severe in patients with proximal occlusion, overall clinical outcomes including long-term outcomes were comparable between the proximal and distal RCA occlusions. Furthermore, multivariate analysis showed that the proximal RCA occlusion was not associated with MACE after hospital discharge.
左冠状动脉闭塞所致ST段抬高型心肌梗死（STEMI）患者中，近端闭塞患者的临床结局比非近端闭塞患者更差。然而，很少有报告关注STEMI患者近端与非近端右冠状动脉（RCA）闭塞的临床结局比较。
我们纳入了356例梗死相关动脉为RCA的STEMI患者，并将他们分为近端组（n = 129）和非近端组（n = 227）。根据美国心脏协会的报告系统，我们将RCA的第1段定义为近端，第2、3和4段定义为非近端。主要终点是主要心血管事件（MACE），其定义为全因死亡、非致命性心肌梗死、因心力衰竭再次入院以及缺血驱动的靶血管血运重建的复合终点。
近端组入院时休克发生率、经皮冠状动脉介入治疗（PCI）期间儿茶酚胺需求或PCI期间机械支持需求倾向于高于非近端组（42.6%）（33.5%）（p = 0.088）。尽管近端组右心室梗死发生率倾向于高于非近端组（17.8%）（10.6%），但未达到统计学意义（p = 0.072），两组住院死亡率相似（1.6%对1.8%，p = 1.000）。两组无MACE生存曲线无差异（p = 0.400）。多变量Cox风险分析显示，近端RCA闭塞与MACE无关（HR 1.095，95%CI 0.691 - 1.737，p = 0.699）。
尽管近端闭塞患者的休克或右心室梗死等急性期情况往往更严重，但近端与远端RCA闭塞之间的总体临床结局（包括长期结局）具有可比性。此外，多变量分析显示，近端RCA闭塞与出院后MACE无关。
