Xiang Guangze, Cao Gaoyang, Gao Menghan, Hu Tianli, He Wujian, Gu Chunxia, Hong Xulin
Department of Cardiology, Heart Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Cardiovasc Med. 2024 Oct 23;11:1382374. doi: 10.3389/fcvm.2024.1382374. eCollection 2024.
This study aims to explore the association between risk stratification and total occlusion (TO) of the culprit artery and multivessel disease (MVD) in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and to obtain more data on clinical decision-making in addition to risk stratification.
We retrospectively collected data from 835 patients with NSTEMI admitted to our hospital between 1 January 2016 and 1 August 2022. All patients underwent percutaneous coronary intervention (PCI) within 72 h of admission. We excluded patients with a history of cardiac arrest, myocardial infarction, coronary artery bypass grafting, or PCI. Univariate and multivariate regression analyses were performed to determine the predictors of acute TO and MVD.
A total of 349 (41.8%) patients presented with a TO culprit vessel, whereas 486 (58.2%) had a patent culprit vessel. Thrombolysis in myocardial infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk stratifications were similar between the two groups of patients ( = 0.712 and 0.991, respectively). The TO infarct vessel was more commonly observed in the left circumflex artery. Patients with TO were more likely to develop MVD ( = 0.004). Univariate and multivariate linear regression analyses were performed to evaluate the role of variables in the presence of TO and MVD in patients with NSTEMI. Regional wall motion abnormalities (RWMAs) [odds ratio (OR) = 4.022; confidence interval (CI): 2.782-5.813; < 0.001] were significantly linked to TO after adjusting for potentially related variables. Furthermore, age (OR = 1.032; CI: 1.018-1.047; < 0.001), hypertension (OR = 1.499; CI: 1.048-2.144; = 0.027), and diabetes mellitus (OR = 3.007; CI: 1.764-5.125; < 0.001) were independent predictors of MVD in patients with NSTEMI. TIMI and GRACE risk scores were related to MVD prevalence in the multivariate logistic regression model. Patients with a TO culprit vessel had a higher risk of out-of-hospital cardiac death after a 2-year follow-up compared with those without a TO culprit vessel ( = 0.022).
TIMI and GRACE risk scores were not associated with a TO of the culprit artery; however, they correlated with the prevalence of MVD in patients with NSTEMI. RWMA is an independent predictor of acute TO in patients with NSTEMI. Patients with a TO culprit vessel had worse clinical outcomes than those without a TO culprit vessel.
本研究旨在探讨非ST段抬高型心肌梗死（NSTEMI）患者的风险分层与罪犯血管完全闭塞（TO）及多支血管病变（MVD）之间的关联，并获取除风险分层之外更多关于临床决策的数据。
我们回顾性收集了2016年1月1日至2022年8月1日期间我院收治的835例NSTEMI患者的数据。所有患者均在入院72小时内接受了经皮冠状动脉介入治疗（PCI）。我们排除了有心脏骤停、心肌梗死、冠状动脉旁路移植术或PCI病史的患者。进行单因素和多因素回归分析以确定急性TO和MVD的预测因素。
共有349例（41.8%）患者出现罪犯血管TO，而486例（58.2%）患者的罪犯血管通畅。两组患者的心肌梗死溶栓（TIMI）和急性冠状动脉事件全球注册（GRACE）风险分层相似（分别为=0.712和0.991）。TO梗死血管更常见于左旋支动脉。TO患者更易发生MVD（=0.004）。进行单因素和多因素线性回归分析以评估变量在NSTEMI患者出现TO和MVD时的作用。在校正潜在相关变量后，局部室壁运动异常（RWMA）[比值比（OR）=4.022；置信区间（CI）：2.782 - 5.813；<0.001]与TO显著相关。此外，年龄（OR = 1.032；CI：1.018 - 1.047；<0.001）、高血压（OR = 1.499；CI：1.048 - 2.144；=0.027）和糖尿病（OR = 3.007；CI：1.764 - 5.125；<0.001）是NSTEMI患者MVD的独立预测因素。TIMI和GRACE风险评分与多因素逻辑回归模型中的MVD患病率相关。与无罪犯血管TO的患者相比，有罪犯血管TO的患者在2年随访后发生院外心脏死亡的风险更高（=0.022）。
TIMI和GRACE风险评分与罪犯动脉TO无关；然而，它们与NSTEMI患者的MVD患病率相关。RWMA是NSTEMI患者急性TO的独立预测因素。有罪犯血管TO的患者临床结局比无罪犯血管TO的患者更差。
